Provider Demographics
NPI:1891209789
Name:PHOENIX EQUESTRIAN WARRIORS-RESCUE-REHAB & RESTORE INC.
Entity type:Organization
Organization Name:PHOENIX EQUESTRIAN WARRIORS-RESCUE-REHAB & RESTORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:CONLEY-MORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-766-6729
Mailing Address - Street 1:8855 CENTER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1421
Mailing Address - Country:US
Mailing Address - Phone:315-766-6729
Mailing Address - Fax:315-303-5892
Practice Address - Street 1:8855 CENTER POINTE DR
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1421
Practice Address - Country:US
Practice Address - Phone:315-766-6729
Practice Address - Fax:315-303-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health