MEDICARE: RANCHO ESCONDIDO THERAPEUTIC RIDING & EQUINE ASSISTED THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1700224276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO ESCONDIDO THERAPEUTIC RIDING & EQUINE ASSISTED THERAPY, INC.

Provider Business Mailing Address
First Line	:	5386 SANTA TERESITA DR
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9204
Country	:	US
Telephone Number	:	575-332-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	5386 SANTA TERESITA DR
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9204
Country	:	US
Telephone Number	:	575-332-4111
Fax Number	:

Authorized Official
Title or Position	:	CONTACT
Name	:	MR. LESTER HIRSCH
Credential	:
Telephone Number	:	915-731-2785

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	02/25/2019

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