Provider Demographics
NPI:1215208459
Name:STABLESTRIDES
Entity Type:Organization
Organization Name:STABLESTRIDES
Other - Org Name:ACTS 19:11
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-495-3908
Mailing Address - Street 1:13620 HALLELUIAH TRL
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-9020
Mailing Address - Country:US
Mailing Address - Phone:719-495-3908
Mailing Address - Fax:719-494-1689
Practice Address - Street 1:13620 HALLELUIAH TRL
Practice Address - Street 2:
Practice Address - City:ELBERT
Practice Address - State:CO
Practice Address - Zip Code:80106-9020
Practice Address - Country:US
Practice Address - Phone:719-495-3908
Practice Address - Fax:719-494-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X, 106H00000X, 225100000X, 225X00000X, 235Z00000X, 261QM0850X
CO743251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health