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General NPI Number Information
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NPI Number | 1518397306
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Entity Type | Organization
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Legal Business Name | EBONY HORSEWOMEN, INC
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 337 VINE ST
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City | HARTFORD
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State | CT
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Zip | 06112-2028
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Country | US
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Telephone | 860-293-2914
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Fax | 860-293-0039
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Provider Business Mailing Address
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Address Line | 337 VINE STREET
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City | HARTFORD
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State | CT
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Zip | 06112
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Country | US
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Telephone | 860-293-2914
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Fax | 860-293-0039
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MRS. PATRICIA ELAINE KELLY
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Credential |
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Telephone | 860-293-2914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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