| Stephen Holtsford Enterprises, Llc. | |
|
3n845 Emily Dickinson Ln St Charles IL 60175-7797 | |
| (630) 881-5698 | |
| Not Available |
| Full Name | Stephen Holtsford Enterprises, Llc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3n845 Emily Dickinson Ln, St Charles, Illinois |
| Authorized Official Name and Position | Stephen R Holtsford (OWNER) |
| Authorized Official Contact | 6308815698 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stephen Holtsford Enterprises, Llc. 3n845 Emily Dickinson Ln St Charles IL 60175-7797 Ph: (630) 881-5698 | Stephen Holtsford Enterprises, Llc. 3n845 Emily Dickinson Ln St Charles IL 60175-7797 Ph: (630) 881-5698 |
| NPI Number | 1851119572 |
|---|---|
| Provider Enumeration Date | 10/01/2024 |
| Last Update Date | 03/24/2025 |
| Medicare PECOS PAC ID | 6901320514 |
|---|---|
| Medicare Enrollment ID | O20250404001129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851119572 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
| Provider Name | Stephen R Holtsford |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1801979463 PECOS PAC ID: 2466448329 Enrollment ID: I20240815003098 |
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