Provider Demographics
NPI:1174317754
Name:GROUNDED STARS LLC
Entity type:Organization
Organization Name:GROUNDED STARS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIERRA
Authorized Official - Middle Name:ELSIE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:803-280-6982
Mailing Address - Street 1:535 FIFTH AVENUE, 4TH FLOOR
Mailing Address - Street 2:#1021
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:914-294-4639
Mailing Address - Fax:917-277-7178
Practice Address - Street 1:1850 AMSTERDAM AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031
Practice Address - Country:US
Practice Address - Phone:914-294-4639
Practice Address - Fax:917-277-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty