Provider Demographics
NPI:1124475132
Name:GRAND VALLEY EQUINE ASSISTED LEARNING CENTER
Entity type:Organization
Organization Name:GRAND VALLEY EQUINE ASSISTED LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUINDER
Authorized Official - Prefix:
Authorized Official - First Name:JAY D.
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-216-8723
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-0308
Mailing Address - Country:US
Mailing Address - Phone:970-216-8723
Mailing Address - Fax:
Practice Address - Street 1:979 25 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9778
Practice Address - Country:US
Practice Address - Phone:970-216-8723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8986225XP0019X
COLPC0012779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty