Healthcare Provider Details

I. General information

NPI: 1487563250
Provider Name (Legal Business Name): STELLARIS KEYSTONE FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11510 JOHN MARSHALL HWY
MARKHAM VA
22643-1802
US

IV. Provider business mailing address

11510 JOHN MARSHALL HWY
MARKHAM VA
22643-1802
US

V. Phone/Fax

Practice location:
  • Phone: 571-364-9550
  • Fax:
Mailing address:
  • Phone: 571-364-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MAROLYN ABENA BOAHEN
Title or Position: FOUNDER
Credential:
Phone: 571-364-9550