1548512890 NPI number — STRONGHOLD EQUINE ASSISTED THERAPY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548512890 NPI number — STRONGHOLD EQUINE ASSISTED THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRONGHOLD EQUINE ASSISTED THERAPY
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:
SEAT
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:
1548512890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 314
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARCE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85625-0314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-730-5401
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3661 E ANTELOPE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARCE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85625-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-730-5401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ANTHONY
Authorized Official First Name:
CYNDI
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR OF THERAPY
Authorized Official Telephone Number:
520-730-5401

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  0019 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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