Healthcare Provider Details

I. General information

NPI: 1730628306
Provider Name (Legal Business Name): UNICORN THERAPEUTIC HORSEBACK RIDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MARSHALL CORNER WOODSVILLE RD
PENNINGTON NJ
08534-3703
US

IV. Provider business mailing address

171 MARSHALL CORNER WOODSVILLE RD
PENNINGTON NJ
08534-3703
US

V. Phone/Fax

Practice location:
  • Phone: 609-354-2014
  • Fax:
Mailing address:
  • Phone: 609-354-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: ERIN L HURLEY
Title or Position: DIRECTOR
Credential:
Phone: 609-354-2014