Provider Demographics
NPI:1346616984
Name:7 CITIES OUTREACH SADDLE CLUB, INC.
Entity Type:Organization
Organization Name:7 CITIES OUTREACH SADDLE CLUB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYLL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-218-8233
Mailing Address - Street 1:5070 MINERAL SPRING RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23438-9621
Mailing Address - Country:US
Mailing Address - Phone:757-218-8233
Mailing Address - Fax:
Practice Address - Street 1:5070 MINERAL SPRING RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23438-9621
Practice Address - Country:US
Practice Address - Phone:757-218-8233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-18
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639198153Medicaid