=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508941105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HORIZON BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 04/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3410 OLD FOREST RD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-2915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-455-5342
-----------------------------------------------------
Fax | 434-485-8877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 COURT ST
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24504-1312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-847-8035
-----------------------------------------------------
Fax | 434-485-8877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | JAMIE BURNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-455-5342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------