Marie Star, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

10-1215GH Issued in FL

Legal business name

MARIE STAR, INC.

Practice address

11471 NW 35TH St
Sunrise, FL 33323-1419

Phone

(954) 742-6349

Fax

(954) 749-8560

NPI assigned

Nov 29, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Marie-Stuart Deravile

Title

President

Phone

(954) 742-6349

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Stuie Manor Doing business as

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237852800000",
    "number": "1821165192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11471 NW 35TH ST",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333231419",
            "telephone_number": "954-742-6349",
            "fax_number": "954-749-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11471 NW 35TH ST",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333231419",
            "telephone_number": "954-742-6349",
            "fax_number": "954-749-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIE STAR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2009-03-24",
        "status": "A",
        "authorized_official_last_name": "DERAVILE",
        "authorized_official_first_name": "MARIE-STUART",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-742-6349",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "10-1215GH",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "FL",
            "license": "10-1215GH",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "686881996",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "686881997",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stuie Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marek Health Alliance LLC
• Martin Marenus, DO
• Joshua Antony Mariafrancis
• Aileen Iris Reyes Mariano, P.T.
• Reynold Guevara Mariano
• Edgar A. Marin, MD
• Kayla Marin
• Mark P Caruso, OD, PA
• Mark S Willner MD PA
• Francine Marks-Weinstein, L.M.H.C.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Sunrise, FL
• Providers in Sunrise, FL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2009; 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.