Provider Demographics
NPI:1003157587
Name:CHEFF THERAPEUTIC RIDING CENTER
Entity type:Organization
Organization Name:CHEFF THERAPEUTIC RIDING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-731-4471
Mailing Address - Street 1:8450 N 43RD ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49012-9651
Mailing Address - Country:US
Mailing Address - Phone:269-731-4471
Mailing Address - Fax:269-731-2990
Practice Address - Street 1:8450 N 43RD ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:MI
Practice Address - Zip Code:49012-9651
Practice Address - Country:US
Practice Address - Phone:269-731-4471
Practice Address - Fax:269-731-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01080764261QH0700X
MI5501005239261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech