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General NPI Number Information
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NPI Number | 1336443118
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Entity Type | Organization
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Legal Business Name | SPECIAL NEEDS RIDE WITH EASE & HORSES FOR OUR HEROES
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 2175 BEACON DR
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5627
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Country | US
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Telephone | 941-979-7428
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Fax |
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Provider Business Mailing Address
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Address Line | 2175 BEACON DR
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-1677
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Country | US
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Telephone | 941-979-7428
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LORREN GARDNER
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Credential | PHD
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Telephone | 941-979-7428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | N10000009604
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License Number State | FL
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