Healthcare Provider Details

I. General information

NPI: 1730921081
Provider Name (Legal Business Name): NEW HORIZONS INTERVENTION SERVICES. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 06/08/2024
Certification Date: 06/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 OAKLAND DR
ELGIN SC
29045-9279
US

IV. Provider business mailing address

1057 OAKLAND DR
ELGIN SC
29045-9279
US

V. Phone/Fax

Practice location:
  • Phone: 754-779-0584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE TAVAREZ LOPEZ
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential: LPES
Phone: 754-779-0584