Provider Demographics
NPI:1427508589
Name:STELLAR CARE AND SERVICES, LLC
Entity type:Organization
Organization Name:STELLAR CARE AND SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HEDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-344-8931
Mailing Address - Street 1:685 CITADEL DR E
Mailing Address - Street 2:SUITE 125
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5314
Mailing Address - Country:US
Mailing Address - Phone:719-344-8931
Mailing Address - Fax:866-372-8722
Practice Address - Street 1:685 CITADEL DR E
Practice Address - Street 2:SUITE 125
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5314
Practice Address - Country:US
Practice Address - Phone:719-344-8931
Practice Address - Fax:866-372-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO52125050Medicaid