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General NPI Number Information
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NPI Number | 1023611522
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Entity Type | Organization
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Legal Business Name | STELLAR HEARTS COMMUNITY SERVICES, LLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 1882 BROOKWOOD RD
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City | NORFOLK
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State | VA
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Zip | 23518-3126
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Country | US
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Telephone | 757-419-1030
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Fax | 757-610-9531
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Provider Business Mailing Address
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Address Line | 1882 BROOKWOOD RD
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City | NORFOLK
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State | VA
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Zip | 23518-3126
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Country | US
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Telephone | 757-419-1030
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Fax | 757-610-9531
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHEAL BROWNSON
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Credential |
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Telephone | 757-419-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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