Healthcare Provider Details

I. General information

NPI: 1477745677
Provider Name (Legal Business Name): CEDAR CREEK THERAPEUTIC RIDING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4895 E HIGHWAY 163
COLUMBIA MO
65201-9284
US

IV. Provider business mailing address

4895 E HIGHWAY 163
COLUMBIA MO
65201-9284
US

V. Phone/Fax

Practice location:
  • Phone: 573-875-8556
  • Fax:
Mailing address:
  • Phone: 573-875-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberOC1064
License Number StateMO

VIII. Authorized Official

Name: KAREN ANNE GRINDLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-875-8556