Provider Demographics
NPI:1740804491
Name:STRIDES EQUESTRIAN THERAPEUTIC CENTER LLC
Entity type:Organization
Organization Name:STRIDES EQUESTRIAN THERAPEUTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-316-7704
Mailing Address - Street 1:W6769 COLBY FACTORY RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54437-9010
Mailing Address - Country:US
Mailing Address - Phone:715-316-7704
Mailing Address - Fax:
Practice Address - Street 1:W6769 COLBY FACTORY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:WI
Practice Address - Zip Code:54437-9010
Practice Address - Country:US
Practice Address - Phone:715-316-7704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health