Provider Demographics
NPI:1508395393
Name:4 HORSEMEN REHABILITATIVE SERVICES INC.
Entity Type:Organization
Organization Name:4 HORSEMEN REHABILITATIVE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:915-929-1164
Mailing Address - Street 1:1610 VINEBROOK TER NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2977
Mailing Address - Country:US
Mailing Address - Phone:910-224-3562
Mailing Address - Fax:
Practice Address - Street 1:1610 VINEBROOK TER NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2977
Practice Address - Country:US
Practice Address - Phone:910-224-3562
Practice Address - Fax:910-224-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management