Provider Demographics
NPI:1255851481
Name:STELLA MEDICAL CARE LLC
Entity Type:Organization
Organization Name:STELLA MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:DITEODORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-912-7807
Mailing Address - Street 1:34 LAWRENCE HILL RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903
Mailing Address - Country:US
Mailing Address - Phone:203-912-7807
Mailing Address - Fax:203-358-9775
Practice Address - Street 1:VILLA AT STAMFORD 88 ROCK RIMMON RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903
Practice Address - Country:US
Practice Address - Phone:203-912-7807
Practice Address - Fax:203-358-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4729314000000X
363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility