Provider Demographics
NPI:1932554243
Name:STRIDE RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:STRIDE RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-654-3709
Mailing Address - Street 1:2747 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9214
Mailing Address - Country:US
Mailing Address - Phone:541-654-3709
Mailing Address - Fax:
Practice Address - Street 1:2747 NEWTON ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9214
Practice Address - Country:US
Practice Address - Phone:541-654-3709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR519136253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR519136Medicaid