Healthcare Provider Details

I. General information

NPI: 1669494274
Provider Name (Legal Business Name): STELLA MARIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WASHINGTON AVE
CLEVELAND OH
44113-2333
US

IV. Provider business mailing address

1320 WASHINGTON AVE
CLEVELAND OH
44113-2333
US

V. Phone/Fax

Practice location:
  • Phone: 216-781-0550
  • Fax: 216-781-7501
Mailing address:
  • Phone: 216-781-0550
  • Fax: 216-781-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. MARGARET ROCHE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-781-0550