Healthcare Provider Details

I. General information

NPI: 1083071682
Provider Name (Legal Business Name): NEW HORIZONS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7235 BONNEVAL RD
JACKSONVILLE FL
32256-7565
US

IV. Provider business mailing address

1348 WESTGATE CENTER DR STE B1
WINSTON SALEM NC
27103-2984
US

V. Phone/Fax

Practice location:
  • Phone: 336-391-7393
  • Fax:
Mailing address:
  • Phone: 336-391-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANDRA CROMARTIE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 336-391-7393