Provider Demographics
NPI:1982161402
Name:HORSE-PLAY OUTDOOR CENTER, INC
Entity Type:Organization
Organization Name:HORSE-PLAY OUTDOOR CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKENBROD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:479-283-7899
Mailing Address - Street 1:902 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-8417
Mailing Address - Country:US
Mailing Address - Phone:479-283-7899
Mailing Address - Fax:
Practice Address - Street 1:902 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-8417
Practice Address - Country:US
Practice Address - Phone:479-283-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty