Healthcare Provider Details

I. General information

NPI: 1013505676
Provider Name (Legal Business Name): STRIDES BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TOLL GATE RD
WARWICK RI
02886-2717
US

IV. Provider business mailing address

600 TOLL GATE RD
WARWICK RI
02886-2717
US

V. Phone/Fax

Practice location:
  • Phone: 401-477-9495
  • Fax:
Mailing address:
  • Phone: 401-477-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL E RUDLOFF
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MS, BCBA, LBA, LABA
Phone: 401-477-9495