=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508988684
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HORIZON SUPPORT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 714 CANYON RIM RD
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-0024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-737-9309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 714 CANYON RIM RD
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-0024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-737-9309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KATHERINE E WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-737-9309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 251B00000X
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------