| Hippodrome State Theatre | |
|
25 Se 2nd Pl Gainesville FL 32601-6567 | |
| (352) 373-5968 | |
| (352) 371-9130 |
| Full Name | Hippodrome State Theatre |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 25 Se 2nd Pl, Gainesville, Florida |
| Authorized Official Name and Position | Mary Hausch (PRODUCING DIRECTOR) |
| Authorized Official Contact | 3523735968 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hippodrome State Theatre 25 Se 2nd Pl Gainesville FL 32601-6567 Ph: (352) 373-5968 | Hippodrome State Theatre 25 Se 2nd Pl Gainesville FL 32601-6567 Ph: (352) 373-5968 |
| NPI Number | 1558365833 |
|---|---|
| Provider Enumeration Date | 06/02/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558365833 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 0301AD068701 (Florida) | Primary |
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