Star Supportive Services, LLC.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

STAR SUPPORTIVE SERVICES, LLC.

Practice address

4470 W 78TH Street Cir
Bloomington, MN 55435-5408

Phone

(612) 446-5353

NPI assigned

Oct 7, 2024

Organization subpart

No

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

Authorized official

Name

Fardowso Isse

Title

Co-Owner

Phone

(612) 703-5300

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1728259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1538988720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4470 W 78TH STREET CIR",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355408",
            "telephone_number": "612-446-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4470 W 78TH STREET CIR",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554355408",
            "telephone_number": "612-446-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR SUPPORTIVE SERVICES, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-07",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-06",
        "status": "A",
        "authorized_official_last_name": "ISSE",
        "authorized_official_first_name": "FARDOWSO",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "612-703-5300"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Stabno
• Elizabeth Lynn Stadler
• Annie Marie Stafford, LADC
• Benjamin Frederick Stagg, OTR/L
• Laine Stanton
• Star Therapy
• Elizabeth Jane Honey Stark, LICSW
• Jolene Stark, LADC
• Jennifer Ruth Starks, MA, LMFT
• State of Minnesota DHS

• Community/Behavioral Health Agency in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 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.