Healthcare Provider Details

I. General information

NPI: 1790482263
Provider Name (Legal Business Name): HOOFBEATS WITH HEART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N IRONWOOD DR STE 115
APACHE JUNCTION AZ
85120-3830
US

IV. Provider business mailing address

PO BOX 2098
HIGLEY AZ
85236-2098
US

V. Phone/Fax

Practice location:
  • Phone: 602-421-7718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLEY HULLIHEN
Title or Position: CEO
Credential:
Phone: 602-421-7718