MEDICARE: STELLAR CARE AND SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	CO
2	347C00000X	Private Vehicle	CO
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215391412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STELLAR CARE AND SERVICES, LLC

Provider Business Mailing Address
First Line	:	612 S COLLEGE AVE
Second Line	:	SUITE 3
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3071
Country	:	US
Telephone Number	:	970-889-6256
Fax Number	:	866-372-8722

Provider Business Practice Location Address
First Line	:	612 S COLLEGE AVE
Second Line	:	SUITE 3
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3071
Country	:	US
Telephone Number	:	970-889-6256
Fax Number	:	866-372-8722

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. ROBERT A HEDDEN
Credential	:	MM
Telephone Number	:	719-344-8931

Provider Enumeration Date	:	04/13/2016
Last Update Date	:	04/13/2016

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Directions to “STELLAR CARE AND SERVICES, LLC ” Practice Location

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