Provider Demographics
NPI:1568080786
Name:STEDFAST HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:STEDFAST HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:THREAT
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:770-299-1378
Mailing Address - Street 1:478 NORTHDALE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8902
Mailing Address - Country:US
Mailing Address - Phone:770-299-1378
Mailing Address - Fax:678-878-4636
Practice Address - Street 1:478 NORTHDALE RD STE 201
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8902
Practice Address - Country:US
Practice Address - Phone:770-299-1378
Practice Address - Fax:678-878-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA067-R-1804OtherPRIVATE HOME CARE PROVIDER PERMIT