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NPI Code Detail

MEDICARE: HORIZON SANDRA LTD

MEDICARE: HORIZON SANDRA LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/CenterIL

General Provider Information

NPI Number : 1093927402
Entity Type Code : Organization
Provider Name (Legal Business Name) : HORIZON SANDRA LTD
Provider Business Mailing Address
First Line : 4403 W LAWRENCE AVE APT 209
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2513
Country : US
Telephone Number : 773-736-4444
Fax Number : 773-283-4849
Provider Business Practice Location Address
First Line : 4403 W LAWRENCE AVE APT 209
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2513
Country : US
Telephone Number : 773-736-4444
Fax Number : 773-283-4849
Authorized Official
Title or Position : PRESIDENT
Name : MS. SANDRA R MCGOWAN
Credential : M.D.
Telephone Number : 773-736-4444
Provider Enumeration Date : 05/06/2007
Last Update Date : 08/22/2020

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Directions to “HORIZON SANDRA LTD ” Practice Location

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