Healthcare Provider Details

I. General information

NPI: 1306279476
Provider Name (Legal Business Name): HORIZON SUNROOMS & SPAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 W NINE MILE RD
PENSACOLA FL
32534-1668
US

IV. Provider business mailing address

1257 W NINE MILE RD
PENSACOLA FL
32534-1668
US

V. Phone/Fax

Practice location:
  • Phone: 850-969-0697
  • Fax: 850-969-0597
Mailing address:
  • Phone: 850-969-0697
  • Fax: 850-969-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number21083
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License NumberRX11066706
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberRX11066706
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID G RADEMACHER
Title or Position: PRESIDENT
Credential:
Phone: 850-969-0697