Provider Demographics
NPI:1255707337
Name:STEADFAST HEALTH SERVICES
Entity type:Organization
Organization Name:STEADFAST HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-482-1940
Mailing Address - Street 1:16781 CHAGRIN BLVD
Mailing Address - Street 2:168
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3721
Mailing Address - Country:US
Mailing Address - Phone:216-510-7941
Mailing Address - Fax:216-510-7948
Practice Address - Street 1:3582 E 154TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4914
Practice Address - Country:US
Practice Address - Phone:216-510-7941
Practice Address - Fax:855-787-3052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189795343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0113537Medicaid