Healthcare Provider Details

I. General information

NPI: 1437082658
Provider Name (Legal Business Name): SKILLBRIDGE RESIDENTIAL TREATMENT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CANDALARIA BLVD S
SALEM OR
97302-4408
US

IV. Provider business mailing address

175 CANDALARIA BLVD S
SALEM OR
97302-4408
US

V. Phone/Fax

Practice location:
  • Phone: 971-335-7698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DANIEL NJOGU
Title or Position: DIRECTOR
Credential:
Phone: 971-335-7698