Sertoma Star Services, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

SERTOMA STAR SERVICES, INC.

Practice address

4331 Lincoln Hwy
Matteson, IL 60443-2404

Phone

(708) 755-8030

NPI assigned

Jan 24, 2024

Organization subpart

No

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

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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.

• Sertoma Star Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago Heights, IL
  • NPI 1053503094
  NPD tax ID
• Sertoma Star Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alsip, IL
  • NPI 1326800517
  NPD tax ID
• Sertoma Star Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alsip, IL
  • NPI 1407618697
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christine M Reynolds, DNP, PMHNP-BC

  • Psychiatry Physician
  • Matteson, IL
  • NPI 1659443810
  Medicare reassignment NPD
• Kasondra Marie Kane

  • Case Manager/Care Coordinator
  • Matteson, IL
  • NPI 1366914376
  NPD (past)
• Rachel Marie Rubino, LCPC, CRC

  • Professional Counselor
  • Wheaton, IL
  • NPI 1184003154
  NPD (past)
• Lauren Sekula

  • Professional Counselor
  • Matteson, IL
  • NPI 1780067983
  NPD (past)

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": "1629830815",
    "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": "4331 LINCOLN HWY",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432404",
            "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": []
}

• Lauren Sekula
• William C Selmer, DDS
• Senior Ally, Inc.
• Sertoma Centre, Inc.
• Sertoma Centre, Inc.
• Sharing Love Transportation Inc
• Sharing Love Transportation LLC
• Trinity Marie Sharp
• Helena Shelby
• Jinan Shetaya, FNP

• Mental Health Clinic/Center (Including Community Mental Health Center) in Matteson, IL
• Providers in Matteson, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.