Healthcare Provider Details

I. General information

NPI: 1255918710
Provider Name (Legal Business Name): STEADFAST CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2569 COPPER CLIFF TRAIL
WOODBURY MN
55125
US

IV. Provider business mailing address

2569 COPPER CLIFF TRAIL
WOODBURY MN
55125
US

V. Phone/Fax

Practice location:
  • Phone: 651-206-8084
  • Fax:
Mailing address:
  • Phone: 651-206-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ROGERS A AKEMBOM
Title or Position: PRESIDENT
Credential:
Phone: 651-206-8084