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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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/CenterOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112602OTHEROHUPI

General Provider Information

NPI Number : 1467598391
Entity Type Code : Organization
Provider Name (Legal Business Name) : STELLA MARIS, INC
Provider Business Mailing Address
First Line : 1320 WASHINGTON AVENUE
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 : 1302 WINSLOW AVENUE
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-2333
Country : US
Telephone Number : 216-781-0550
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. ROBERT LEE SMITH
Credential : PH.D.
Telephone Number : 216-781-0550
Provider Enumeration Date : 01/29/2007
Last Update Date : 10/22/2011

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Directions to “STELLA MARIS, INC ” Practice Location

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