Healthcare Provider Details

I. General information

NPI: 1669974457
Provider Name (Legal Business Name): STELLAR BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3576 ARLINGTON AVE STE 307
RIVERSIDE CA
92506-3988
US

IV. Provider business mailing address

2035 VISTA AVE
SIERRA MADRE CA
91024-1553
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-3188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RICHARD ROWE
Title or Position: OWNER
Credential:
Phone: 951-465-3188