Healthcare Provider Details

I. General information

NPI: 1982227906
Provider Name (Legal Business Name): STCHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S 1ST ST
PHOENIX AZ
85004-2754
US

IV. Provider business mailing address

411 S 1ST ST
PHOENIX AZ
85004-2754
US

V. Phone/Fax

Practice location:
  • Phone: 602-380-6852
  • Fax:
Mailing address:
  • Phone: 602-380-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA VASSEUR
Title or Position: CFO
Credential: CPA
Phone: 602-380-6852