Healthcare Provider Details

I. General information

NPI: 1215411020
Provider Name (Legal Business Name): STELLHORN WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3464 STELLHORN RD
FORT WAYNE IN
46815-4630
US

IV. Provider business mailing address

3464 STELLHORN RD
FORT WAYNE IN
46815-4630
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-6508
  • Fax: 260-432-6586
Mailing address:
  • Phone: 260-432-6508
  • Fax: 260-432-6586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRY LEE YEITER
Title or Position: OWNER
Credential: ETC
Phone: 260-432-6508