Provider Demographics
NPI:1588293633
Name:STELLAR HOME NETWORK
Entity type:Organization
Organization Name:STELLAR HOME NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGUIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-310-8275
Mailing Address - Street 1:3530 W PETERSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3294
Mailing Address - Country:US
Mailing Address - Phone:800-766-0666
Mailing Address - Fax:800-297-0666
Practice Address - Street 1:3530 W PETERSON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3294
Practice Address - Country:US
Practice Address - Phone:312-857-6894
Practice Address - Fax:773-442-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty