Healthcare Provider Details

I. General information

NPI: 1164611760
Provider Name (Legal Business Name): NEW HORIZON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 LORAIN AVE
DURHAM NC
27704-3023
US

IV. Provider business mailing address

801 LORAIN AVE
DURHAM NC
27704-3023
US

V. Phone/Fax

Practice location:
  • Phone: 919-201-0385
  • Fax:
Mailing address:
  • Phone: 919-201-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-032-417
License Number StateNC

VIII. Authorized Official

Name: MRS. TILDA ALLEN
Title or Position: PROGRAM DIRECTOR/OWNER
Credential:
Phone: 919-201-0385