Provider Demographics
NPI:1366763492
Name:TRINITY EQUESTRIAN CENTER
Entity type:Organization
Organization Name:TRINITY EQUESTRIAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER & DIRECTOR OF PROGRAMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-835-4530
Mailing Address - Street 1:S5300 STATE ROAD 37
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-8628
Mailing Address - Country:US
Mailing Address - Phone:715-835-4530
Mailing Address - Fax:715-832-3229
Practice Address - Street 1:S5300 STATE ROAD 37
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-8628
Practice Address - Country:US
Practice Address - Phone:715-835-4530
Practice Address - Fax:715-832-3229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health