Provider Demographics
NPI:1023611522
Name:STELLAR HEARTS COMMUNITY SERVICES, LLC
Entity type:Organization
Organization Name:STELLAR HEARTS COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-419-1030
Mailing Address - Street 1:1882 BROOKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3126
Mailing Address - Country:US
Mailing Address - Phone:757-419-1030
Mailing Address - Fax:757-610-9531
Practice Address - Street 1:1882 BROOKWOOD RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3126
Practice Address - Country:US
Practice Address - Phone:757-419-1030
Practice Address - Fax:757-610-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities