Healthcare Provider Details

I. General information

NPI: 1174123517
Provider Name (Legal Business Name): NATIONAL EQUINE INSTITUTE OF GROWTH THROUGH HEALING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4696 MAPLE GROVE RD
BEMUS POINT NY
14712-9516
US

IV. Provider business mailing address

PO BOX 104
GERRY NY
14740-0104
US

V. Phone/Fax

Practice location:
  • Phone: 716-338-5350
  • Fax:
Mailing address:
  • Phone: 716-338-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWN I SAMUELSON
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential: BA
Phone: 716-338-5350