Provider Demographics
NPI:1447806732
Name:TRIPLE 777 RANCH & EQUINE REHAB FACILITY
Entity Type:Organization
Organization Name:TRIPLE 777 RANCH & EQUINE REHAB FACILITY
Other - Org Name:TRIPLE 777 RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:ALKIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-564-6572
Mailing Address - Street 1:7039 COUNTY ROAD 57
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9638
Mailing Address - Country:US
Mailing Address - Phone:419-564-6572
Mailing Address - Fax:
Practice Address - Street 1:7039 COUNTY ROAD 57
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-9638
Practice Address - Country:US
Practice Address - Phone:419-564-6572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty