Healthcare Provider Details

I. General information

NPI: 1902063522
Provider Name (Legal Business Name): HORIZON VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 INDUCON DR E
SANBORN NY
14132-9014
US

IV. Provider business mailing address

6301 INDUCON DR E
SANBORN NY
14132-9014
US

V. Phone/Fax

Practice location:
  • Phone: 716-731-2030
  • Fax: 716-731-3010
Mailing address:
  • Phone: 716-731-2030
  • Fax: 716-731-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number101YA0400X
License Number StateNY

VIII. Authorized Official

Name: MS. MARYETTA LEWIS
Title or Position: COUNSELOR
Credential:
Phone: 716-731-2030