Provider Demographics
NPI:1114255254
Name:STELLAR HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:STELLAR HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:STELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS ADM HUMAN SERV
Authorized Official - Phone:469-951-3950
Mailing Address - Street 1:2100 N HIGHWAY 360
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1011
Mailing Address - Country:US
Mailing Address - Phone:214-412-3428
Mailing Address - Fax:
Practice Address - Street 1:2100 N HIGHWAY 360
Practice Address - Street 2:SUITE 1105
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1011
Practice Address - Country:US
Practice Address - Phone:214-412-3528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19779547171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty