| Steadfast Wellness Llc | |
|
100 W Overland Rd Ste 201 Meridian ID 83642-3053 | |
| (541) 690-7221 | |
| Not Available |
| Full Name | Steadfast Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 W Overland Rd Ste 201, Meridian, Idaho |
| Authorized Official Name and Position | Angel Ford (OWNER) |
| Authorized Official Contact | 5416907221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Steadfast Wellness Llc 100 W Overland Rd Ste 201 Meridian ID 83642-3053 Ph: () - | Steadfast Wellness Llc 100 W Overland Rd Ste 201 Meridian ID 83642-3053 Ph: (541) 690-7221 |
| NPI Number | 1750042511 |
|---|---|
| Provider Enumeration Date | 01/04/2022 |
| Last Update Date | 03/17/2022 |
| Certification Date | 03/17/2022 |
| Medicare PECOS PAC ID | 9739566944 |
|---|---|
| Medicare Enrollment ID | O20220509002017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750042511 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Angel M Ford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114307626 PECOS PAC ID: 6204184971 Enrollment ID: I20180813002116 |
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