Provider Demographics
NPI:1174135032
Name:NORTH STAR FOUNDATION
Entity type:Organization
Organization Name:NORTH STAR FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:DOBBS
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MA IN ED PSYCH
Authorized Official - Phone:860-423-0664
Mailing Address - Street 1:20 DEERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2712
Mailing Address - Country:US
Mailing Address - Phone:860-423-0664
Mailing Address - Fax:
Practice Address - Street 1:20 DEERFIELD LN
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06268-2712
Practice Address - Country:US
Practice Address - Phone:860-423-0664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health