| Organization Name: | STAR ACADEMY FOR YOUTH |
| NPI Number: | 1831323195 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFF BATHKE (PROGRAM ADMINISTRATOR) |
| Mailing Address: | 12279 Brady Dr Custer |
| State: | SD US |
| Postal Code: | 577309160 |
| Phone Number: | 6056732521 |
| Fax Number: | 6056734654 |
| NPI Enumeration Date: | 05/14/2009 |
| NPI Last Update Date: | 05/14/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 5000360 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |