Provider Demographics
NPI:1851119572
Name:STEPHEN HOLTSFORD ENTERPRISES, LLC.
Entity type:Organization
Organization Name:STEPHEN HOLTSFORD ENTERPRISES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-881-5698
Mailing Address - Street 1:3N845 EMILY DICKINSON LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7797
Mailing Address - Country:US
Mailing Address - Phone:630-881-5698
Mailing Address - Fax:
Practice Address - Street 1:3N845 EMILY DICKINSON LN
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7797
Practice Address - Country:US
Practice Address - Phone:630-881-5698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center