1215418959 NPI number — COURAGE REINS

Table of content: (NPI 1215418959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215418959 NPI number — COURAGE REINS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COURAGE REINS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COURAGE REINS EQUINE ASSISTED THERAPIES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215418959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5870 W 10400 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84003-9569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-756-8900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5870 W 10400 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84003-9569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-756-8900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CELAYA
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF MENTAL HEALTH
Authorized Official Telephone Number:
801-362-3585

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  6573731-6006 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YS0200X , with the licence number: 426620 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6573731-3501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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