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General NPI Number Information
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NPI Number | 1467347278
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Entity Type | Organization
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Legal Business Name | STEADFAST HEALTH PROFESSIONAL SERVICES OF OHIO INC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 11201 SHAKER BLVD STE 106
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City | CLEVELAND
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State | OH
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Zip | 44104-3833
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Country | US
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Telephone | 866-935-0936
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Fax | 330-319-7828
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Provider Business Mailing Address
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Address Line | 11201 SHAKER BLVD STE 106
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City | CLEVELAND
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State | OH
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Zip | 44104-3833
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Country | US
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Telephone | 866-935-0936
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Fax | 330-319-7828
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Authorized Official
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Title or Position | CCO
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Name | DAVIS STEPHEN
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Credential | MD
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Telephone | 479-422-1581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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