NPIMap

Organization Active NPI

Sertoma Star Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alsip, IL
National Provider Identifier
1407618697
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
SERTOMA STAR SERVICES, INC.
Practice address
4343 W 123Rd St
Alsip, IL 60803-1807
Phone
(708) 755-8030
NPI assigned
Jan 24, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Mental Illness Community Based Residential Treatment Facility 320800000X

Addresses

Primary practice location

4343 W 123Rd St
Alsip, IL 60803-1807

Mailing address

1005 W End Ave
Chicago Heights, IL 60411-2742

National Provider Directory

National Provider Directory
Tax ID family
Sertoma Star Services Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1407618697",
    "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": "4343 W 123RD ST",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608031807",
            "telephone_number": "708-755-8030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERTOMA STAR SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "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": "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": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alsip, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.