Provider Demographics
NPI:1578985115
Name:STELLAR SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:STELLAR SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARVINA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:234-788-3314
Mailing Address - Street 1:1055 BYE ST
Mailing Address - Street 2:541 WEST AVENUE SUITE 1B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-2178
Mailing Address - Country:US
Mailing Address - Phone:234-788-3314
Mailing Address - Fax:
Practice Address - Street 1:541 WEST AVE STE 1B
Practice Address - Street 2:541 WEST AVENUE SUITE 1B
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1790
Practice Address - Country:US
Practice Address - Phone:234-788-3314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH315P00000X315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0095420Medicaid