Organization
HIPPODROME STATE THEATRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY HAUSCH (PRODUCING DIRECTOR)
(352) 373-5968
Entity
Organization
Contact information
Practice address
25 SE 2ND PL, GAINESVILLE, FL 32601-6567
(352) 373-5968
(352) 371-9130
Mailing address
25 SE 2ND PL, GAINESVILLE, FL 32601-6567
(352) 373-5968
(352) 371-9130
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0301AD068701
FL
Other
Enumeration date
06/02/2005
Last updated
08/22/2020
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