STONEYBROOKE RESIDENTIAL SERVICES, LLC (NPI# 1164979191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164979191 |
| Entity Type | Organization |
| Organization Name | STONEYBROOKE RESIDENTIAL SERVICES, LLC |
| Practice Address |
25500 Se Stark St Suite 101 Gresham OR 97030-3331 |
| Practice Telephone | 5036697191 |
| Practice Fax Number | 5036697102 |
| Mailing Telephone | 5036697191 |
| Mailing Fax Number | 5036697102 |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |
| Authorized Official Name | VALERIE STONEY (ASSISTANT DIRECTOR) |
| Authorized Official Telephone | 5036697191 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
25500 SE STARK ST SUITE 101 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-3331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467413179 | Proactive Orthopedic and Sports Physical Therapy of Gresham LLC | Clinic/Center | 25500 Se Stark St, Suite 103, Gresham, OR 97030-3331 | 2006-03-31 |
| 1659746097 | Delia Sewell | Naturopath | 25500 Se Stark St, Suite 102, Gresham, OR 97030-3331 | 2015-12-10 |
| 1265840466 | Karen E Bartling | Physical Therapist | 25500 Se Stark St, Suite 103, Gresham, OR 97030 | 2014-07-31 |
| 1003135088 | Erika Sigrist | Naturopath | 25500 Se Stark St, Gresham, OR 97030-3331 | 2010-05-31 |
| 1205068947 | Alissa A Cameron | Physical Therapist | 25500 Se Stark St, Gresham, Gresham, OR 97030-3331 | 2009-08-13 |
| 1578613790 | Laura M Maatta | Counselor | 25500 Se Stark St, #202, Gresham, OR 97030-3331 | 2007-01-11 |
| 1902964729 | Elizabeth Delplato | Chiropractor | 25500 Se Stark St, Suite 201b, Gresham, OR 97030-3331 | 2006-12-05 |
| 1508822909 | Christopher George Tutt | Physical Therapist | 25500 Se Stark St, Suite 103, Gresham, OR 97030-3331 | 2006-04-25 |
| 1477519874 | Glen Raymond Akers | Physical Therapist | 25500 Se Stark St, Suite 103, Gresham, OR 97030-3331 | 2006-04-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376188896 | Thomas Wayne Stutzman | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 168 Ackerman St E, Monmouth, OR 97361-2214 | 2019-11-07 |
| 1710539119 | Kathy Bailey | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4840 Patricia Ct Ne, Salem, OR 97305-3313 | 2019-07-15 |
| 1255893988 | Ariel Schmidt | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3658 Wiltsey St Se, Salem, OR 97317-9303 | 2019-04-02 |
| 1588921845 | Haven House Treatment Center Corp | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 13565 Sw Singletree Dr, Beaverton, OR 97008-7517 | 2012-04-11 |
| 1407121106 | Sean's Place, Incorporated | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 930 Hammer St, Harrisburg, OR 97446-9590 | 2012-03-13 |
| 1457561524 | Childerns Farm Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2820 Se Glenn St, Corvallis, OR 97333-2121 | 2007-05-23 |
| 1811064447 | Alternative Services Oreogn, Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 11830 Kerr Pkwy, Suite 210, Lake Oswego, OR 97035-1249 | 2006-11-29 |
| 1720023807 | Dept. of Human Srvcs/office of Fin. Srvcs Dba: Irs/eopc/eotc/osh/osh-p | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2525 Westgate, Pendleton, OR 97801-9613 | 2006-06-20 |
| 1043876865 | Home Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5100 Center St Ne, Salem, OR 97317-3217 | 2019-05-16 |
| 1780043802 | Stults House | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 805 Se 151st Ave, Portland, OR 97233-2916 | 2016-02-17 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.