MEDICARE: NEW HORIZONS OF THE TREASURE COAST INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	282N00000X	General Acute Care Hospital
2	261QC1500X	Community Health Clinic/Center
3	208D00000X	General Practice Physician	FL
4	251B00000X	Case Management Agency
5	363A00000X	Physician Assistant	FL
6	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	195893	OTHER	FL	AMERIGROUP
2	00707	OTHER	FL	BLUE CROSS OF FL
3	E16	OTHER	FL	BLUE CROSS OF FLORIDA
4	NI191	OTHER		HEALTHEASE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	157081	OTHER		MANAGED HEALTH NETWORK

General Provider Information

NPI Number	:	1154439958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HORIZONS OF THE TREASURE COAST INC

Provider Business Mailing Address
First Line	:	4500 W MIDWAY RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34981-4823
Country	:	US
Telephone Number	:	772-468-5600
Fax Number	:	772-468-5606

Provider Business Practice Location Address
First Line	:	4500 W. MIDWAY ROAD
Second Line	:
City	:	FT. PIERCE
State	:	FL
Zip	:	34981-4823
Country	:	US
Telephone Number	:	772-468-5600
Fax Number	:	772-468-5606

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. GREGORY J JACKSON
Credential	:
Telephone Number	:	772-468-5600

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/12/2025

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