Provider Demographics
NPI:1710713649
Name:EQUINE ESCAPE
Entity type:Organization
Organization Name:EQUINE ESCAPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-802-2608
Mailing Address - Street 1:5880 BRIGHAM RD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9645
Mailing Address - Country:US
Mailing Address - Phone:810-287-0519
Mailing Address - Fax:
Practice Address - Street 1:5880 BRIGHAM RD
Practice Address - Street 2:
Practice Address - City:GOODRICH
Practice Address - State:MI
Practice Address - Zip Code:48438-9645
Practice Address - Country:US
Practice Address - Phone:810-287-0519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No305S00000XManaged Care OrganizationsPoint of Service