Healthcare Provider Details

I. General information

NPI: 1003797242
Provider Name (Legal Business Name): LIGHTHOUSE RANCH EQUINE THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WATER PLANT RD
ST AUGUSTINE FL
32092-9249
US

IV. Provider business mailing address

7451 ORTEGA HILLS DR
JACKSONVILLE FL
32244-4633
US

V. Phone/Fax

Practice location:
  • Phone: 904-487-9986
  • Fax:
Mailing address:
  • Phone: 904-487-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRIA JONES
Title or Position: EQUINE THERAPIST
Credential: ES, CTAA
Phone: 904-487-9986