| NPI | 1700111002 |
|---|---|
| Other Name | PHOENIX STAR CLUBHOUSE |
| Entity Type | Organization |
| Authorized Contact | JUANITA THORNTON President 540-761-5424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2009-10-05 |