Provider Demographics
NPI:1437256013
Name:FORWARD STRIDE
Entity Type:Organization
Organization Name:FORWARD STRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:HENNECK
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-217-2058
Mailing Address - Street 1:23839 SW DANIEL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-5400
Mailing Address - Country:US
Mailing Address - Phone:503-217-2058
Mailing Address - Fax:503-217-2168
Practice Address - Street 1:23839 SW DANIEL RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078-5400
Practice Address - Country:US
Practice Address - Phone:503-217-2058
Practice Address - Fax:503-217-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center