Provider Demographics
NPI:1649241068
Name:STELLA MARIS INC
Entity Type:Organization
Organization Name:STELLA MARIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAIBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-252-4500
Mailing Address - Street 1:2300 DULANEY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2739
Mailing Address - Country:US
Mailing Address - Phone:410-252-4500
Mailing Address - Fax:410-560-9685
Practice Address - Street 1:2300 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2739
Practice Address - Country:US
Practice Address - Phone:410-252-4500
Practice Address - Fax:410-560-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03-041314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD751500600Medicaid
MD960200300Medicaid
MD215117Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MD4853870001Medicare NSC