Healthcare Provider Details

I. General information

NPI: 1467598391
Provider Name (Legal Business Name): STELLA MARIS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 WINSLOW AVENUE
CLEVELAND OH
44113-2333
US

IV. Provider business mailing address

1320 WASHINGTON AVENUE
CLEVELAND OH
44113-2333
US

V. Phone/Fax

Practice location:
  • Phone: 216-781-0550
  • Fax:
Mailing address:
  • Phone: 216-781-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT LEE SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 216-781-0550