NPI 1255450979

S.T.A.R.T Neurodevelopment Assessment and Treatment Center

Organisation Preferred Provider Organization San Bernardino, CA

Practice location

Address: 164 W Hospitality Ln STE 3, San Bernardino, CA 92408-3328
Phone: (909) 891-1880
Mailing address: 13852 Bluegrass Pl, Victorville, CA 92392-5533

Authorised official

Name: Kim Lakes
Title: Executive Director
Phone: (909) 891-1880

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 42378 (CA)

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Registry record

NPI: 1255450979
Entity type: Organization
NPI issued: 28 Mar 2007
Record last updated: 26 Jun 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.