Provider Demographics
NPI:1659961407
Name:STELLAR HOSPICE LLC
Entity Type:Organization
Organization Name:STELLAR HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TYNAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCLOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-809-1540
Mailing Address - Street 1:3717 HIGHWAY 3 STE C
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8024
Mailing Address - Country:US
Mailing Address - Phone:409-233-1118
Mailing Address - Fax:409-527-3111
Practice Address - Street 1:3717 HIGHWAY 3 STE C
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8024
Practice Address - Country:US
Practice Address - Phone:409-233-1118
Practice Address - Fax:409-527-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based