Healthcare Provider Details

I. General information

NPI: 1215391412
Provider Name (Legal Business Name): STELLAR CARE AND SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S COLLEGE AVE SUITE 3
FORT COLLINS CO
80524-3071
US

IV. Provider business mailing address

612 S COLLEGE AVE SUITE 3
FORT COLLINS CO
80524-3071
US

V. Phone/Fax

Practice location:
  • Phone: 970-889-6256
  • Fax: 866-372-8722
Mailing address:
  • Phone: 970-889-6256
  • Fax: 866-372-8722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier21076065
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: MR. ROBERT A HEDDEN
Title or Position: OWNER/CEO
Credential: MM
Phone: 719-344-8931