Healthcare Provider Details

I. General information

NPI: 1447806732
Provider Name (Legal Business Name): TRIPLE 777 RANCH & EQUINE REHAB FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 04/04/2020
Certification Date: 04/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7039 COUNTY ROAD 57
MANSFIELD OH
44904-9638
US

IV. Provider business mailing address

7039 COUNTY ROAD 57
MANSFIELD OH
44904-9638
US

V. Phone/Fax

Practice location:
  • Phone: 419-564-6572
  • Fax:
Mailing address:
  • Phone: 419-564-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN RENE ALKIRE
Title or Position: OWNER
Credential:
Phone: 419-564-6572