1831300979 NPI number — C.H.U.M. THERAPEUTIC RIDING, INC

Table of content: (NPI 1831300979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831300979 NPI number — C.H.U.M. THERAPEUTIC RIDING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C.H.U.M. THERAPEUTIC RIDING, INC
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:
Provider Other Organization Name Type Code:
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:
1831300979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48854-0014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-204-0974
Provider Business Mailing Address Fax Number:
517-623-0145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2180 E DEXTER TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANSVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48819-9781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-204-0974
Provider Business Practice Location Address Fax Number:
517-623-0145
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEPUE
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
517-204-0974

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  5201005748 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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