Provider Demographics
NPI:1164979191
Name:STONEYBROOKE RESIDENTIAL SERVICES, LLC
Entity Type:Organization
Organization Name:STONEYBROOKE RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-669-7191
Mailing Address - Street 1:25500 SE STARK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3331
Mailing Address - Country:US
Mailing Address - Phone:503-669-7191
Mailing Address - Fax:503-669-7102
Practice Address - Street 1:25500 SE STARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3331
Practice Address - Country:US
Practice Address - Phone:503-669-7191
Practice Address - Fax:503-669-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities