Healthcare Provider Details

I. General information

NPI: 1891105607
Provider Name (Legal Business Name): HORIZON BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AVOCA LN
ALTAVISTA VA
24517-1154
US

IV. Provider business mailing address

620 COURT ST FIFTH FLOOR
LYNCHBURG VA
24504-1312
US

V. Phone/Fax

Practice location:
  • Phone: 434-369-7187
  • Fax: 434-369-4149
Mailing address:
  • Phone: 434-485-8861
  • Fax: 434-485-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateVA

VIII. Authorized Official

Name: MS. ASHLEY VAUGHAN
Title or Position: REIMBURSEMENT MANAGER
Credential:
Phone: 434-485-8861