Healthcare Provider Details

I. General information

NPI: 1548771900
Provider Name (Legal Business Name): HORIZON WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 SMITH ST
NORTH PROVIDENCE RI
02908
US

IV. Provider business mailing address

1830 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-3864
US

V. Phone/Fax

Practice location:
  • Phone: 401-383-9600
  • Fax: 401-369-7474
Mailing address:
  • Phone: 401-351-1900
  • Fax: 401-270-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES CROSS
Title or Position: OFFICE ADMIN
Credential:
Phone: 401-615-7311