Healthcare Provider Details

I. General information

NPI: 1679103196
Provider Name (Legal Business Name): BETTER HORIZONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18491 E ASHRIDGE DR
QUEEN CREEK AZ
85142-3619
US

IV. Provider business mailing address

2204 E FIRESTONE DR
CHANDLER AZ
85249-4636
US

V. Phone/Fax

Practice location:
  • Phone: 602-400-7764
  • Fax:
Mailing address:
  • Phone: 602-400-7764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CLARISSE KAMGAING
Title or Position: CEO
Credential:
Phone: 602-400-7764