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General NPI Number Information
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NPI Number | 1336797935
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Entity Type | Organization
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Legal Business Name | COURAGE THERAPEUTIC RIDING CENTER, INC.
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 12922 HOGEYE RD
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City | PRAIRIE GROVE
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State | AR
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Zip | 72753-8462
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Country | US
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Telephone | 479-883-9468
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9976
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-0034
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Country | US
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Telephone | 479-883-9468
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | ALEXANDRIA ROSE KERR
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Credential |
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Telephone | 479-883-9468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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