Healthcare Provider Details

I. General information

NPI: 1669607164
Provider Name (Legal Business Name): BEYOND THE HORIZON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S COX ST
ASHEBORO NC
27203-6461
US

IV. Provider business mailing address

3717 OAKWOOD AVE
CHARLOTTE NC
28205-1233
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-3335
  • Fax:
Mailing address:
  • Phone: 704-206-9592
  • Fax: 704-383-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KAI KIMANA GREENE
Title or Position: EXECUTIVE BUSINESS DIRECTOR/CEO
Credential: B.S AP
Phone: 704-206-9592