Provider Demographics
NPI:1336443118
Name:SPECIAL NEEDS RIDE WITH EASE & HORSES FOR OUR HEROES
Entity Type:Organization
Organization Name:SPECIAL NEEDS RIDE WITH EASE & HORSES FOR OUR HEROES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-979-7428
Mailing Address - Street 1:2175 BEACON DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-1677
Mailing Address - Country:US
Mailing Address - Phone:941-979-7428
Mailing Address - Fax:
Practice Address - Street 1:2175 BEACON DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5627
Practice Address - Country:US
Practice Address - Phone:941-979-7428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLN10000009604385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care