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General NPI Number Information
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NPI Number | 1013064757
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Entity Type | Organization
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Legal Business Name | COCHISE AREA NETWORK FOR THERAPEUTIC EQUESTRIAN RESOURCES
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 7388 E CHIEF JOSEPH DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85650-8520
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Country | US
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Telephone | 520-378-3196
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Fax | 520-366-0038
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Provider Business Mailing Address
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Address Line | PO BOX 1316
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City | SIERRA VISTA
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State | AZ
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Zip | 85636-1316
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Country | US
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Telephone | 520-378-3196
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Fax |
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Authorized Official
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Title or Position | BOATD PRESIDENT
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Name | MR. PETER A. KELLY
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Credential |
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Telephone | 520-366-0112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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