Healthcare Provider Details

I. General information

NPI: 1316046956
Provider Name (Legal Business Name): HORIZONS CENTER FOR INDEPENDENT LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 WILLIAMS ST
PARKERSBURG WV
26101-4851
US

IV. Provider business mailing address

934 WILLIAMS ST
PARKERSBURG WV
26101-4851
US

V. Phone/Fax

Practice location:
  • Phone: 304-428-7799
  • Fax: 304-428-7766
Mailing address:
  • Phone: 304-428-7799
  • Fax: 304-428-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number26
License Number StateWV

VIII. Authorized Official

Name: MR. DAVID LEWIS
Title or Position: PRESIDENT
Credential:
Phone: 304-295-7546