Healthcare Provider Details

I. General information

NPI: 1376984088
Provider Name (Legal Business Name): HORIZONS, A FAMILY SERVICE ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 5TH ST SE
CEDAR RAPIDS IA
52401-2128
US

IV. Provider business mailing address

819 5TH ST SE
CEDAR RAPIDS IA
52401-2128
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-3943
  • Fax: 319-398-3577
Mailing address:
  • Phone: 319-398-3943
  • Fax: 319-398-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0001247
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerIOWA STATE LICENSE

VIII. Authorized Official

Name: MR. JAMES MCGOLDRICK
Title or Position: CHIEF FINANCIAL ADVISOR
Credential:
Phone: 319-398-3943