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General NPI Number Information
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NPI Number | 1588012637
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Entity Type | Organization
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Legal Business Name | STEADFAST ADVOCACY FOR MEANINGFUL INDEPENDENCE LLC
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 614 N 14TH ST
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City | SABETHA
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State | KS
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Zip | 66534-1520
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Country | US
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Telephone | 785-285-8424
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Fax |
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Provider Business Mailing Address
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Address Line | 614 N 14TH ST
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City | SABETHA
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State | KS
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Zip | 66534-1520
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Country | US
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Telephone | 785-285-8424
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | SAMANTHA L BOLDRA
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Credential |
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Telephone | 785-285-8424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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