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NPI Code Detail

MEDICARE: STELLA MARIS, INC.

MEDICARE: STELLA MARIS, INC.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center0679OH

General Provider Information

NPI Number : 1366708638
Entity Type Code : Organization
Provider Name (Legal Business Name) : STELLA MARIS, INC.
Provider Business Mailing Address
First Line : 1320 WASHINGTON AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-2333
Country : US
Telephone Number : 216-781-0550
Fax Number :
Provider Business Practice Location Address
First Line : 1320 WASHINGTON AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-2333
Country : US
Telephone Number : 216-781-0550
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. DENNIS MADDEN
Credential :
Telephone Number : 216-781-0550
Provider Enumeration Date : 04/11/2012
Last Update Date : 04/11/2012

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Directions to “STELLA MARIS, INC. ” Practice Location

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