Provider Demographics
NPI:1649411554
Name:GREAT STRIDES
Entity Type:Organization
Organization Name:GREAT STRIDES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HOYT
Authorized Official - Last Name:OLIN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:203-272-7862
Mailing Address - Street 1:689 YALESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2932
Mailing Address - Country:US
Mailing Address - Phone:203-272-7862
Mailing Address - Fax:203-272-3834
Practice Address - Street 1:335 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2549
Practice Address - Country:US
Practice Address - Phone:203-272-7862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment