Healthcare Provider Details

I. General information

NPI: 1154439958
Provider Name (Legal Business Name): NEW HORIZONS OF THE TREASURE COAST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W. MIDWAY ROAD
FT. PIERCE FL
34981-4823
US

IV. Provider business mailing address

4500 W MIDWAY RD
FORT PIERCE FL
34981-4823
US

V. Phone/Fax

Practice location:
  • Phone: 772-468-5600
  • Fax: 772-468-5606
Mailing address:
  • Phone: 772-468-5600
  • Fax: 772-468-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. GREGORY J JACKSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 772-468-5600