Healthcare Provider Details

I. General information

NPI: 1760685770
Provider Name (Legal Business Name): LIVINGSTON COUNTY NEW HORIZONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CLINEFELTER ST BOX 203
CHILLICOTHEE MO
64601-2348
US

IV. Provider business mailing address

920 CLINEFELTER ST BOX 203
CHILLICOTHEE MO
64601-2348
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-1513
  • Fax:
Mailing address:
  • Phone: 660-646-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESIA O'NEAL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 660-646-1513