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General NPI Number Information
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NPI Number | 1407035983
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Entity Type | Organization
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Legal Business Name | STELLA RD ASSISTED LIVING
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 1847 STELLA AVE
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City | DALLAS
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State | TX
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Zip | 75203-4225
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Country | US
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Telephone | 214-948-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 1847 STELLA AVE
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City | DALLAS
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State | TX
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Zip | 75203-4225
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Country | US
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Telephone | 214-948-1399
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. AVIS L YOUNG SR.
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Credential |
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Telephone | 214-942-3215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 121668
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License Number State | TX
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