MEDICARE: NEW HORIZON COMMUNITY SERVICES

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	363L00000X	Nurse Practitioner
2	251S00000X	Community/Behavioral Health Agency	C001341	NC
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1881975936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HORIZON COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	800 BRIAR CREEK RD
Second Line	:	SUITE DD-202
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6903
Country	:	US
Telephone Number	:	704-206-1270
Fax Number	:	704-665-5715

Provider Business Practice Location Address
First Line	:	800 BRIAR CREEK RD
Second Line	:	SUITE DD-202
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6903
Country	:	US
Telephone Number	:	704-206-1270
Fax Number	:	704-665-5715

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. IDRIS TALIB
Credential	:
Telephone Number	:	704-206-1270

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	07/23/2012

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