Healthcare Provider Details

I. General information

NPI: 1912361627
Provider Name (Legal Business Name): NEW HORIZONS COMMUNITY SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 WILLIAM ST
JEFFERSON CITY MO
65109-4771
US

IV. Provider business mailing address

2013 WILLIAM ST
JEFFERSON CITY MO
65109-4771
US

V. Phone/Fax

Practice location:
  • Phone: 573-636-8108
  • Fax: 573-635-9892
Mailing address:
  • Phone: 573-636-8108
  • Fax: 573-635-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHI CHEUNG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 573-636-8108