Healthcare Provider Details

I. General information

NPI: 1992240386
Provider Name (Legal Business Name): NEW HORIZONS BRISTOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 SHELBY ST
BRISTOL TN
37620-2240
US

IV. Provider business mailing address

619 SHELBY ST
BRISTOL TN
37620-2240
US

V. Phone/Fax

Practice location:
  • Phone: 423-652-0611
  • Fax: 423-652-0629
Mailing address:
  • Phone: 423-652-0611
  • Fax: 423-652-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1000000019291
License Number StateTN

VIII. Authorized Official

Name: BARRY WAYNE SALEWSKY
Title or Position: OWNER
Credential: RN
Phone: 276-243-6085