Provider Demographics
NPI:1932480761
Name:RILEY EQUINE CENTER, INC.
Entity Type:Organization
Organization Name:RILEY EQUINE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:660-537-0302
Mailing Address - Street 1:17244 DOYLE RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-3500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:660-882-7137
Practice Address - Street 1:17244 DOYLE RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-3500
Practice Address - Country:US
Practice Address - Phone:660-882-6400
Practice Address - Fax:660-882-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services