Healthcare Provider Details

I. General information

NPI: 1144156514
Provider Name (Legal Business Name): STEADFAST PROMISE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 ROSEBUD AVE
SAINT LOUIS MO
63121-5631
US

IV. Provider business mailing address

6182 BAY TREE DR
FLORISSANT MO
63033-4743
US

V. Phone/Fax

Practice location:
  • Phone: 557-218-3977
  • Fax:
Mailing address:
  • Phone: 557-218-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIARA JOHNSON-SMITH
Title or Position: OWNER
Credential:
Phone: 557-218-3977