Provider Demographics
NPI:1568045193
Name:RIDE HOME EQUINE THERAPY
Entity Type:Organization
Organization Name:RIDE HOME EQUINE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECCCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:ASBERT
Authorized Official - Suffix:
Authorized Official - Credentials:EQUINE THERAPY
Authorized Official - Phone:425-504-1161
Mailing Address - Street 1:12433 ADMIRALTY WAY APT C105
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-8038
Mailing Address - Country:US
Mailing Address - Phone:425-504-1161
Mailing Address - Fax:
Practice Address - Street 1:27703 SR 9
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7392
Practice Address - Country:US
Practice Address - Phone:925-864-2659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604720718Medicaid
WA604720718OtherNON PROFIT