Provider Demographics
NPI:1043933575
Name:JAKE E-S RIDING ROUND UP
Entity type:Organization
Organization Name:JAKE E-S RIDING ROUND UP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SYVRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-458-9578
Mailing Address - Street 1:10626 FARM TO MARKET 429
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142
Mailing Address - Country:US
Mailing Address - Phone:214-458-9578
Mailing Address - Fax:
Practice Address - Street 1:10626 FARM TO MARKET 429
Practice Address - Street 2:
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142
Practice Address - Country:US
Practice Address - Phone:214-458-9578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy