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General NPI Number Information
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NPI Number | 1306072780
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Entity Type | Organization
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Legal Business Name | PROSPECT MOUNTAIN THERAPEUTIC RIDING CENTER
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Dates
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Enumeration Date | 05/30/2009
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Last Update Date | 05/30/2009
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Provider Practice Location Address
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Address Line | 7471 FM 3094
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City | SCURRY
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State | TX
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Zip | 75158-4915
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Country | US
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Telephone | 469-595-2019
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Fax | 972-452-3331
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Provider Business Mailing Address
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Address Line | 7471 FM 3094
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City | SCURRY
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State | TX
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Zip | 75158-4915
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Country | US
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Telephone | 469-595-2019
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Fax | 972-452-3331
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Authorized Official
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Title or Position | INSTRUCTOR, CEO
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Name | THERESA RAE LISENBY
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Credential | INSTRUCTOR R.N.
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Telephone | 469-595-2019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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Taxonomy #6
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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