Provider Demographics
NPI:1467297556
Name:HORSE HERITAGE EDUCATIONAL PROGRAM
Entity type:Organization
Organization Name:HORSE HERITAGE EDUCATIONAL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOTR
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-844-2556
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99181-0048
Mailing Address - Country:US
Mailing Address - Phone:509-844-2556
Mailing Address - Fax:
Practice Address - Street 1:3150 CHURCH RD
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99181-9756
Practice Address - Country:US
Practice Address - Phone:509-844-2556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child