MEDICARE: SKILLBRIDGE RESIDENTIAL TREATMENT HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1437082658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKILLBRIDGE RESIDENTIAL TREATMENT HOME LLC

Provider Business Mailing Address
First Line	:	175 CANDALARIA BLVD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 CANDALARIA BLVD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4408
Country	:	US
Telephone Number	:	971-335-7698
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DANIEL NJOGU
Credential	:
Telephone Number	:	971-335-7698

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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