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General NPI Number Information
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NPI Number | 1568080786
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Entity Type | Organization
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Legal Business Name | STEDFAST HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 478 NORTHDALE RD STE 201
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8902
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Country | US
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Telephone | 770-299-1378
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Fax | 678-878-4636
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Provider Business Mailing Address
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Address Line | 478 NORTHDALE RD STE 201
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8902
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Country | US
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Telephone | 770-299-1378
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Fax | 678-878-4636
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | YOLANDA P THREAT
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Credential | REGISTERED NURSE
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Telephone | 770-299-1378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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