Provider Demographics
NPI:1851848766
Name:HEAVEN'S GAIT THERAPEUTIC RIDING, INC
Entity Type:Organization
Organization Name:HEAVEN'S GAIT THERAPEUTIC RIDING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-656-5764
Mailing Address - Street 1:2471 E CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2471 E CHEROKEE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2000
Practice Address - Country:US
Practice Address - Phone:770-656-5764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80218174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
80218OtherPATH INTERNATIONAL CERTIFICATION