=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407165640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED HORIZON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2010
-----------------------------------------------------
Last Update Date | 10/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14007 ROSEMONT AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48223-3581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-526-6403
-----------------------------------------------------
Fax | 313-493-9935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14007 ROSEMONT AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48223-3581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-526-6403
-----------------------------------------------------
Fax | 313-493-9935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ALEXANDER THOMAS JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-443-1544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------