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General NPI Number Information
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NPI Number | 1548627961
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Entity Type | Organization
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Legal Business Name | STELLAR LIVING ENTERPRISES , INC
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Dates
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Enumeration Date | 01/16/2016
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Last Update Date | 01/16/2016
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Provider Practice Location Address
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Address Line | 2191 PINETOP LN UNIT # 108
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City | LAS VEGAS
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State | NV
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Zip | 89119-7812
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Country | US
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Telephone | 702-806-1380
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Fax |
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Provider Business Mailing Address
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Address Line | 2191 PINETOP LN UNIT # 108
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City | LAS VEGAS
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State | NV
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Zip | 89119-7812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DEXTER DESHA WEATHERS
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Credential |
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Telephone | 702-806-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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