Stellbrook Management, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

STELLBROOK MANAGEMENT, LLC

Practice address

404 Walnut St
Doniphan, MO 63935-1420

Phone

(573) 712-2992

NPI assigned

Nov 10, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacob Hogg

Title

Administrator

Phone

(573) 712-2992

Specialties & licenses 1

Addresses

Other names 1

• Walnut Street Assisted Living Doing business as

Tax ID family

Stellbrook Management LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Stellbrook Management, LLC

  • Assisted Living Facility
  • Doniphan, MO
  • NPI 1033873088
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1760148183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 W MAUD ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014819",
            "telephone_number": "573-712-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 WALNUT ST",
            "city": "DONIPHAN",
            "state": "MO",
            "postal_code": "639351420",
            "telephone_number": "573-712-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLBROOK MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-10",
        "last_updated": "2021-11-10",
        "certification_date": "2021-10-26",
        "status": "A",
        "authorized_official_last_name": "HOGG",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-712-2992"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walnut Street Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southeast Health Center of Ripley County
• Southeast Health Center of Ripley County
• Southeast Health Center of Ripley County
• Macey Stcin, COTA
• Stellbrook Management, LLC
• Super D Drugs Acquisition Co.
• Shelby Anakia Talburt, RDH
• Jason Lynn Vernon
• Vision Improvement Clinic, LLC
• Wilkare Pharmacy of Doniphan

• Assisted Living Facility in Doniphan, MO
• Providers in Doniphan, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.