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Capital City Shining Stars

Community/Behavioral Health in Petersburg, VA. Organization (NPI-2).

NPI number1326675497
StatusActive
Last updated in NPPESMay 29, 2024

Details

NPI
1326675497
Entity type
Organization (NPI-2)
Legal business name
Capital City Shining Stars
Organization subpart
No
Enumeration date
Mar 26, 2020
Certification date
May 29, 2024
Last updated
May 29, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251S00000X Community/Behavioral Health––Yes
251C00000X Day Training, Developmentally Disabled Services––
320800000X Community Based Residential Treatment Facility, Mental Illness––
320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities––

Practice location

1201 Commerce St
Petersburg, VA 23803-2904

Phone 804-715-2621 · Fax 804-800-4250

Mailing address

Po Box 1870
Chesterfield, VA 23832-9108

Phone 804-715-2621 · Fax 804-800-4250

Authorized official

Alicia Star Wills
Owner
8047152621

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