Healthcare Provider Details

I. General information

NPI: 1003157587
Provider Name (Legal Business Name): CHEFF THERAPEUTIC RIDING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8450 N 43RD ST
AUGUSTA MI
49012-9651
US

IV. Provider business mailing address

8450 N 43RD ST
AUGUSTA MI
49012-9651
US

V. Phone/Fax

Practice location:
  • Phone: 269-731-4471
  • Fax: 269-731-2990
Mailing address:
  • Phone: 269-731-4471
  • Fax: 269-731-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number01080764
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501005239
License Number StateMI

VIII. Authorized Official

Name: SANRA J CULVER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 269-731-4471