Provider Demographics
NPI:1932932498
Name:GIANT CITY STABLES LLC
Entity type:Organization
Organization Name:GIANT CITY STABLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MBR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TWELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CTRI
Authorized Official - Phone:618-529-4110
Mailing Address - Street 1:722 GIANT CITY RD
Mailing Address - Street 2:
Mailing Address - City:MAKANDA
Mailing Address - State:IL
Mailing Address - Zip Code:62958-3200
Mailing Address - Country:US
Mailing Address - Phone:618-529-4110
Mailing Address - Fax:
Practice Address - Street 1:722 GIANT CITY RD
Practice Address - Street 2:
Practice Address - City:MAKANDA
Practice Address - State:IL
Practice Address - Zip Code:62958-3200
Practice Address - Country:US
Practice Address - Phone:618-529-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty