Healthcare Provider Details

I. General information

NPI: 1164718060
Provider Name (Legal Business Name): HORIZON FOUNDATION D/B/A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 CHRISTINE ST STE 4
CAPE GIRARDEAU MO
63703-5810
US

IV. Provider business mailing address

353 CHRISTINE ST STE 4
CAPE GIRARDEAU MO
63703-5810
US

V. Phone/Fax

Practice location:
  • Phone: 573-335-5443
  • Fax: 573-335-0103
Mailing address:
  • Phone: 573-335-5443
  • Fax: 573-335-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1243
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1243
License Number StateMO

VIII. Authorized Official

Name: MR. JAMES DANIEL SHANDY
Title or Position: OWNER
Credential: B.A.,BC-HIS
Phone: 573-335-5443