Provider Demographics
NPI:1225370265
Name:BROMLEY KINGS FARM EQUESTRIAN COMPANY, LLC
Entity Type:Organization
Organization Name:BROMLEY KINGS FARM EQUESTRIAN COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-705-1730
Mailing Address - Street 1:146 CHENEY RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1332
Mailing Address - Country:US
Mailing Address - Phone:860-705-1730
Mailing Address - Fax:860-365-5318
Practice Address - Street 1:3-5 EAST HAMPTON RD, MARLBOROUGH TAVERN GREEN
Practice Address - Street 2:UNIT 5
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1527
Practice Address - Country:US
Practice Address - Phone:860-705-1730
Practice Address - Fax:860-365-5318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-17
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001734101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty