Healthcare Provider Details

I. General information

NPI: 1912228586
Provider Name (Legal Business Name): STEADFAST REHABILITATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4513 TWEEDSMUIR TURN
MOSELEY VA
23120-1287
US

IV. Provider business mailing address

4513 TWEEDSMUIR TURN
MOSELEY VA
23120-1287
US

V. Phone/Fax

Practice location:
  • Phone: 804-513-3810
  • Fax: 804-639-7124
Mailing address:
  • Phone: 804-513-3810
  • Fax: 804-639-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2202001943
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2202001943
License Number StateVA

VIII. Authorized Official

Name: MRS. LINDA FLAMM
Title or Position: PRESIDENT
Credential: M.S. CCC-SLP
Phone: 804-513-3810