Provider Demographics
NPI:1346428109
Name:HORSE HOLIDAY
Entity Type:Organization
Organization Name:HORSE HOLIDAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PROGRAM DESIGNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-658-3861
Mailing Address - Street 1:1919 ULSH GAP RD
Mailing Address - Street 2:
Mailing Address - City:MC CLURE
Mailing Address - State:PA
Mailing Address - Zip Code:17841-8217
Mailing Address - Country:US
Mailing Address - Phone:570-658-3861
Mailing Address - Fax:
Practice Address - Street 1:1919 ULSH GAP RD
Practice Address - Street 2:
Practice Address - City:MC CLURE
Practice Address - State:PA
Practice Address - Zip Code:17841-8217
Practice Address - Country:US
Practice Address - Phone:570-658-3861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261Q00000X
261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health