MEDICARE: BRAND NEW HORIZON INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1548681943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAND NEW HORIZON INC

Provider Business Mailing Address
First Line	:	4029 BONITA DESERT CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3472
Country	:	US
Telephone Number	:	702-580-5991
Fax Number	:

Provider Business Practice Location Address
First Line	:	4029 BONITA DESERT CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3472
Country	:	US
Telephone Number	:	702-580-5991
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THERESA DAVIS
Credential	:
Telephone Number	:	702-580-5991

Provider Enumeration Date	:	01/02/2014
Last Update Date	:	01/02/2014

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