Provider Demographics
NPI:1497812333
Name:GREATER STRIDES
Entity Type:Organization
Organization Name:GREATER STRIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:UNDERWOOD-SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-350-9597
Mailing Address - Street 1:112 HAMPSHIRE CV
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1380
Mailing Address - Country:US
Mailing Address - Phone:440-350-9597
Mailing Address - Fax:440-350-9597
Practice Address - Street 1:112 HAMPSHIRE CV
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1380
Practice Address - Country:US
Practice Address - Phone:440-350-9597
Practice Address - Fax:440-350-9597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4301375OtherODMRDD CONTRACT NUMBER
OH2706423Medicaid