Basic Information
| Provider Information | |||||||||
| NPI: | 1265447015 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STARLITE RECOVERY CENTER, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | STARLITE RECOVERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 317 | ||||||||
| Address2: | |||||||||
| City: | CENTER POINT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780100317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306342212 | ||||||||
| FaxNumber: | 8306342532 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 MESA VERDE DRIVE EAST | ||||||||
| Address2: | |||||||||
| City: | CENTER POINT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306342212 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT & SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 6158616000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 4428-4429 | 01 | TX | SUBSTANCE ABUSE TREATMENT FACILITY LICENSE - ADULT OUTPATIENT | OTHER | 4428-4431 | 01 | TX | SUBSTANCE ABUSE TREATMENT FACILITY LICENSE-INTENSIVE RESIDENTIAL | OTHER | 4428-4432 | 01 | TX | SUBSTANCE ABUSE TREATMENT FACILITY LICENSE-INTENSIVE RESIDENTIAL | OTHER | 4428-4433 | 01 | TX | SUBSTANCE ABUSE TREATMENT FACILITY LICENSE-IR/OP/DETOX-ADOLESCENT | OTHER | 4428-4430 | 01 | TX | SUBSTANCE ABUSE TREATMENT FACILITY LICENSE-IR/OP/RESIDENT | OTHER |