Provider Demographics
NPI:1548491962
Name:MOLEBASH, STELLA LOUISE (PCA)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:LOUISE
Last Name:MOLEBASH
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 N BRIDGE ST
Mailing Address - Street 2:APT# 711
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-4133
Mailing Address - Country:US
Mailing Address - Phone:740-773-0556
Mailing Address - Fax:
Practice Address - Street 1:1920 N BRIDGE ST
Practice Address - Street 2:APT# 711
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4133
Practice Address - Country:US
Practice Address - Phone:740-773-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2937442Medicaid