Healthcare Provider Details

I. General information

NPI: 1679168736
Provider Name (Legal Business Name): HORSES HELP FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2601 E ROSE GARDEN LN
PHOENIX AZ
85050-4605
US

IV. Provider business mailing address

PO BOX 71005
PHOENIX AZ
85050-1001
US

V. Phone/Fax

Practice location:
  • Phone: 602-569-6056
  • Fax: 602-218-6766
Mailing address:
  • Phone: 602-569-6056
  • Fax: 602-218-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GREGG STEPHEN GOODMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 602-569-6056