Active NPI
Sertoma Star Services, Inc.
Doing business as SouthSTAR Services
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Chicago Heights, IL
National Provider Identifier
1053503094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Legal business name
- SERTOMA STAR SERVICES, INC.
- Doing business as
- SouthSTAR Services
- Practice address
- 1005 W End Ave
Chicago Heights, IL 60411-2742 - Phone
- (708) 755-8030
- Fax
- (708) 755-8047
- NPI assigned
- Aug 14, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gus Van Den Brink
- Title
- President/Ceo
- Phone
- (708) 730-6216
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | 946232 | IL | |
| Community/Behavioral Health Agency | 251S00000X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Primary | ||
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | 946232 | IL | |
| Mental Illness Community Based Residential Treatment Facility | 320800000X |
Addresses
Primary practice location
1005 W End Ave
Chicago Heights, IL 60411-2742
Mailing address
1005 W End Ave
Chicago Heights, IL 60411-2742
Other practice location 1
4331 Lincoln Hwy
Matteson, IL 60443-2404
Phone (708) 748-1951
Other practice location 2
4343 W 123rd St
Alsip, IL 60803-1807
Phone (708) 371-9700
Other practice location 3
4100 W 127th St
Alsip, IL 60803-1925
Phone (708) 371-9700
Other names 1
- SouthSTAR Services
National Provider Directory
National Provider Directory- Tax ID family
- Sertoma Star Services Inc
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Alsip, IL
- NPI 1326800517
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Alsip, IL
- NPI 1407618697
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Matteson, IL
- NPI 1629830815
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/sertomastar/r4/
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187049600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1707696000000",
"number": "1053503094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1005 W END AVE",
"city": "CHICAGO HEIGHTS",
"state": "IL",
"postal_code": "604112742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 W END AVE",
"city": "CHICAGO HEIGHTS",
"state": "IL",
"postal_code": "604112742",
"telephone_number": "708-755-8030",
"fax_number": "708-755-8047"
}
],
"practiceLocations": [
{
"address_1": "4331 Lincoln Hwy",
"address_purpose": "LOCATION",
"city": "Matteson",
"state": "IL",
"postal_code": "604432404",
"country_code": "US",
"telephone_number": "708-748-1951",
"fax_number": "708-755-8047",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4343 W 123rd St",
"address_purpose": "LOCATION",
"city": "Alsip",
"state": "IL",
"postal_code": "608031807",
"country_code": "US",
"telephone_number": "708-371-9700",
"fax_number": "708-755-8047",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4100 W 127th St",
"address_purpose": "LOCATION",
"city": "Alsip",
"state": "IL",
"postal_code": "608031925",
"country_code": "US",
"telephone_number": "708-371-9700",
"fax_number": "708-755-8047",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "SERTOMA STAR SERVICES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-08-14",
"last_updated": "2024-02-12",
"certification_date": "2024-02-12",
"status": "A",
"authorized_official_last_name": "VAN DEN BRINK",
"authorized_official_first_name": "GUS",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "708-730-6216"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": "IL",
"license": "946232",
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": true
},
{
"code": "320600000X",
"taxonomy_group": "",
"desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "IL",
"license": "946232",
"primary": false
},
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "SouthSTAR Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Chicago Heights, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.