Provider Demographics
NPI:1912408477
Name:MEDICINE HORSE FARM CORP
Entity Type:Organization
Organization Name:MEDICINE HORSE FARM CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ INSTRUCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:POSTIGLIONE-DUPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-566-7217
Mailing Address - Street 1:38 LIZZIES LANE
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962
Mailing Address - Country:US
Mailing Address - Phone:518-566-7217
Mailing Address - Fax:
Practice Address - Street 1:38 LIZZIES LANE
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962
Practice Address - Country:US
Practice Address - Phone:518-566-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03257509OtherMEDICAID PROVIDER #