Basic Information
| Provider Information | |||||||||
| NPI: | 1275865693 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCKING HORSE CHILDREN'S HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ROCKING HORSE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 S LIMESTONE ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 455051965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373241111 | ||||||||
| FaxNumber: | 9375254541 | ||||||||
| Practice Location | |||||||||
| Address1: | 54 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431401085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373241111 | ||||||||
| FaxNumber: | 9375254541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2010 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | WALLACE | ||||||||
| AuthorizedOfficialFirstName: | SHONDA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9373241111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.