Provider Demographics
NPI:1215391412
Name:STELLAR CARE AND SERVICES, LLC
Entity Type:Organization
Organization Name:STELLAR CARE AND SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MM
Authorized Official - Phone:719-344-8931
Mailing Address - Street 1:612 S COLLEGE AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3071
Mailing Address - Country:US
Mailing Address - Phone:970-889-6256
Mailing Address - Fax:866-372-8722
Practice Address - Street 1:612 S COLLEGE AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3071
Practice Address - Country:US
Practice Address - Phone:970-889-6256
Practice Address - Fax:866-372-8722
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STELLAR CARE AND SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251C00000X, 347C00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21076065Medicaid