Provider Demographics
NPI:1821428509
Name:STELLAR HEALTH CARE
Entity Type:Organization
Organization Name:STELLAR HEALTH CARE
Other - Org Name:PHENOMENAL REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-543-1104
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:HOWARD LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55349-0737
Mailing Address - Country:US
Mailing Address - Phone:320-543-1104
Mailing Address - Fax:320-543-1105
Practice Address - Street 1:1116 6TH STREET
Practice Address - Street 2:
Practice Address - City:HOWARD LAKE
Practice Address - State:MN
Practice Address - Zip Code:55349
Practice Address - Country:US
Practice Address - Phone:320-543-1104
Practice Address - Fax:320-543-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty