Provider Demographics
NPI:1891961702
Name:MIDWEST THERAPEUTIC EQUESTRIAN HEALTH CENTER
Entity type:Organization
Organization Name:MIDWEST THERAPEUTIC EQUESTRIAN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBARTH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:262-878-2000
Mailing Address - Street 1:PO BOX 085184
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53408-5184
Mailing Address - Country:US
Mailing Address - Phone:262-878-2000
Mailing Address - Fax:262-878-2000
Practice Address - Street 1:1117 N BRITTON RD
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9305
Practice Address - Country:US
Practice Address - Phone:262-878-2000
Practice Address - Fax:262-878-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41219700Medicaid
WI41219700Medicaid