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General NPI Number Information
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NPI Number | 1427558493
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Entity Type | Organization
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Legal Business Name | STEADFAST SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 1432 CROOKED STICK DR
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City | O FALLON
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State | MO
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Zip | 63366-5556
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Country | US
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Telephone | 636-614-5627
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Fax |
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Provider Business Mailing Address
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Address Line | 1432 CROOKED STICK DR
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City | O FALLON
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State | MO
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Zip | 63366-5556
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Country | US
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Telephone | 636-614-5627
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NOAL WINSTON PRESLEY
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Credential |
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Telephone | 636-614-5627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | MO
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