Provider Demographics
NPI:1134684699
Name:STELLAE-AHP-MDCAID LLC
Entity Type:Organization
Organization Name:STELLAE-AHP-MDCAID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENCIBIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-284-7484
Mailing Address - Street 1:8323 NW 12TH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1839
Mailing Address - Country:US
Mailing Address - Phone:305-284-7484
Mailing Address - Fax:305-667-8860
Practice Address - Street 1:8323 NW 12TH ST STE 115
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1839
Practice Address - Country:US
Practice Address - Phone:305-284-7484
Practice Address - Fax:305-667-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service