Provider Demographics
NPI:1407035983
Name:STELLA RD ASSISTED LIVING
Entity Type:Organization
Organization Name:STELLA RD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:214-942-3215
Mailing Address - Street 1:1847 STELLA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-4225
Mailing Address - Country:US
Mailing Address - Phone:214-948-1399
Mailing Address - Fax:
Practice Address - Street 1:1847 STELLA AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-4225
Practice Address - Country:US
Practice Address - Phone:214-948-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121668302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization