Provider Demographics
NPI:1194169037
Name:HAVEN HILLS THERAPEUTIC RIDING CENTER, INC.
Entity type:Organization
Organization Name:HAVEN HILLS THERAPEUTIC RIDING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED REHABILITATION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HEILI
Authorized Official - Middle Name:S
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:CRC
Authorized Official - Phone:770-371-7531
Mailing Address - Street 1:7580 RIVERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2403
Mailing Address - Country:US
Mailing Address - Phone:678-296-9693
Mailing Address - Fax:
Practice Address - Street 1:7580 RIVERTOWN RD
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2403
Practice Address - Country:US
Practice Address - Phone:678-296-9693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00116431261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation