Basic Information
| Provider Information | |||||||||
| NPI: | 1225540214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STELLAR HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1818 NEW YORK AVE NE STE 110C | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200021849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026365136 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1818 NEW YORK AVE NE STE 110C | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200021849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026365136 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2017 | ||||||||
| LastUpdateDate: | 10/30/2017 | ||||||||
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| AuthorizedOfficialLastName: | OKETOKUN | ||||||||
| AuthorizedOfficialFirstName: | ADEFOLAJU | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3018320100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | MD038372 | DC | N | Agencies | Case Management | 251C00000X | MD038372 | DC | N | Agencies | Day Training, Developmentally Disabled Services | 253Z00000X | MD038372 | DC | N | Agencies | In Home Supportive Care | 261QA0600X | MD038372 | DC | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | 261QM0801X | MD038372 | DC | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 323P00000X | MD038372 | DC | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 324500000X | MD038372 | DC | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 251S00000X | MD038372 | DC | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1003005661 | 05 | DC | MEDICAID |