Provider Demographics
NPI:1700380011
Name:STRIDEABILITY LLC
Entity Type:Organization
Organization Name:STRIDEABILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMELLE
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-294-6002
Mailing Address - Street 1:21 HAMPTON PLACE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110
Mailing Address - Country:US
Mailing Address - Phone:917-294-6002
Mailing Address - Fax:
Practice Address - Street 1:328 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-4428
Practice Address - Country:US
Practice Address - Phone:917-294-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0676861Medicaid