MEDICARE: GREAT HORIZONS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	253Z00000X	In Home Supportive Care Agency
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1679300115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT HORIZONS

Provider Business Mailing Address
First Line	:	4120 THORNTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1751
Country	:	US
Telephone Number	:	419-469-7790
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 THORNTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1751
Country	:	US
Telephone Number	:	419-469-7790
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS DEVONA MARIE TOWNSEND
Credential	:	QMHS
Telephone Number	:	419-464-5124

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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Directions to “GREAT HORIZONS ” Practice Location

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