Healthcare Provider Details

I. General information

NPI: 1801620174
Provider Name (Legal Business Name): PEGASUS SPRINGS THERAPEUTIC RIDING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 OLD STATE RD
NATIONAL CITY MI
48748-9644
US

IV. Provider business mailing address

4800 OLD STATE RD
NATIONAL CITY MI
48748-9644
US

V. Phone/Fax

Practice location:
  • Phone: 989-820-1787
  • Fax:
Mailing address:
  • Phone: 989-820-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA ANN CLARE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 989-820-1787