=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528547890
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HORIZONS IN AUTISM, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2018
-----------------------------------------------------
Last Update Date | 08/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 GRAND AVENUE
-----------------------------------------------------
City | MONTVALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-918-0850
-----------------------------------------------------
Fax | 732-918-0091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 906 ROUTE 33
-----------------------------------------------------
City | FREEHOLD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-918-0850
-----------------------------------------------------
Fax | 732-918-0091
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | JESSICA MULHERN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-918-0850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------