Capital City Shining Stars

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CAPITAL CITY SHINING STARS

Practice address

1201 Commerce St
Petersburg, VA 23803-2904

Phone

(804) 715-2621

Fax

(804) 800-4250

NPI assigned

Mar 26, 2020

Last updated

May 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Alicia Star Wills

Title

Owner

Phone

(804) 715-2621

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1326675497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1870",
            "city": "CHESTERFIELD",
            "state": "VA",
            "postal_code": "238329108",
            "telephone_number": "804-715-2621",
            "fax_number": "804-800-4250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 COMMERCE ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238032904",
            "telephone_number": "804-715-2621",
            "fax_number": "804-800-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL CITY SHINING STARS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-26",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "WILLS",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "STAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-715-2621",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 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.

Verify at the official NPI Registry.