Healthcare Provider Details

I. General information

NPI: 1245548072
Provider Name (Legal Business Name): SUGAR CREEK EQUINAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21407 E 58 HWY
PLEASANT HILL MO
64080-8514
US

IV. Provider business mailing address

32914 S EVERS RD
GARDEN CITY MO
64747-8393
US

V. Phone/Fax

Practice location:
  • Phone: 816-824-4968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MORGAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-824-4968