Healthcare Provider Details

I. General information

NPI: 1578717799
Provider Name (Legal Business Name): HORIZONS COMMUNITY DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 CHRISTOPHER ST
ORANGE NJ
07050-1238
US

IV. Provider business mailing address

349 FAIRVIEW AVE
ORANGE NJ
07050-2111
US

V. Phone/Fax

Practice location:
  • Phone: 973-414-8112
  • Fax: 973-414-8110
Mailing address:
  • Phone: 973-414-8112
  • Fax: 973-414-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number2000066-08
License Number StateNJ

VIII. Authorized Official

Name: MRS. KARON ELAINE RICE
Title or Position: EXECUTIVE DIRECOR
Credential:
Phone: 973-414-8112