Provider Demographics
NPI:1013071398
Name:LADAWN QUARTER HORSES THERAPEUTIC RIDING CENTER
Entity Type:Organization
Organization Name:LADAWN QUARTER HORSES THERAPEUTIC RIDING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARIVIERE
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR
Authorized Official - Phone:207-499-0080
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:WEST KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04094-0558
Mailing Address - Country:US
Mailing Address - Phone:207-499-0080
Mailing Address - Fax:207-499-2597
Practice Address - Street 1:995 GOODWINS MILLS RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:ME
Practice Address - Zip Code:04005-7348
Practice Address - Country:US
Practice Address - Phone:207-499-0080
Practice Address - Fax:207-499-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1490174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty