Provider Demographics
NPI:1477745677
Name:CEDAR CREEK THERAPEUTIC RIDING CENTER
Entity Type:Organization
Organization Name:CEDAR CREEK THERAPEUTIC RIDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GRINDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-875-8556
Mailing Address - Street 1:4895 E HIGHWAY 163
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-9284
Mailing Address - Country:US
Mailing Address - Phone:573-875-8556
Mailing Address - Fax:
Practice Address - Street 1:4895 E HIGHWAY 163
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-9284
Practice Address - Country:US
Practice Address - Phone:573-875-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOOC1064305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service