# HIPPODROME STATE THEATRE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558365833
- **Authorized official:** MS. MARY HAUSCH (PRODUCING DIRECTOR)
- **Authorized official phone:** (352) 373-5968

## Contact information

- **Practice address:** 25 SE 2ND PL, GAINESVILLE, FL 32601-6567
- **Practice address phone:** (352) 373-5968
- **Practice address fax:** (352) 371-9130
- **Mailing address:** 25 SE 2ND PL, GAINESVILLE, FL 32601-6567
- **Mailing address phone:** (352) 373-5968
- **Mailing address fax:** (352) 371-9130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | 0301AD068701 | FL | Yes |

## Other

- **Enumeration date:** 06/02/2005
- **Last updated:** 08/22/2020