Healthcare Provider Details

I. General information

NPI: 1932149622
Provider Name (Legal Business Name): HORIZON HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 WILHITE CT
LEXINGTON KY
40503-3327
US

IV. Provider business mailing address

1031 WELLINGTON WAY STE 240
LEXINGTON KY
40513-1257
US

V. Phone/Fax

Practice location:
  • Phone: 859-303-8746
  • Fax:
Mailing address:
  • Phone: 859-303-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number700122
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16524
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number17681
License Number StateKY

VIII. Authorized Official

Name: BRITTANY UNDERWOOD
Title or Position: CREDENTIALING AGENT
Credential:
Phone: 859-303-8746