Provider Demographics
NPI:1215294061
Name:HIGH HORSES THERAPEUTIC RIDING PROGRAM
Entity type:Organization
Organization Name:HIGH HORSES THERAPEUTIC RIDING PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-356-3386
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0681
Mailing Address - Country:US
Mailing Address - Phone:802-356-3386
Mailing Address - Fax:
Practice Address - Street 1:2727 CHRISTIAN ST.
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:VT
Practice Address - Zip Code:05088
Practice Address - Country:US
Practice Address - Phone:802-356-3386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-00743842251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT701102068Medicaid