Provider Demographics
NPI:1245629500
Name:SERENITY THERAPEUTIC EQUINE PROGRAM
Entity type:Organization
Organization Name:SERENITY THERAPEUTIC EQUINE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-720-1919
Mailing Address - Street 1:7580 16TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-9776
Mailing Address - Country:US
Mailing Address - Phone:701-833-7911
Mailing Address - Fax:
Practice Address - Street 1:7580 16TH ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-9776
Practice Address - Country:US
Practice Address - Phone:701-833-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty