Provider Demographics
NPI:1063541753
Name:STELLAVILLA
Entity type:Organization
Organization Name:STELLAVILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-593-2539
Mailing Address - Street 1:3848 CAIN MILL DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3868
Mailing Address - Country:US
Mailing Address - Phone:770-593-2539
Mailing Address - Fax:770-593-0691
Practice Address - Street 1:3848 CAIN MILL DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3868
Practice Address - Country:US
Practice Address - Phone:770-593-2539
Practice Address - Fax:770-593-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities