MEDICARE: HORIZON SCIENCE ACADEMY-DAYTON-HIGH SCHOOL

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
1	251300000X	Local Education Agency (LEA)	011534	OH

General Provider Information

NPI Number	:	1992021976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON SCIENCE ACADEMY-DAYTON-HIGH SCHOOL

Provider Business Mailing Address
First Line	:	250 SHOUP MILL RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3517
Country	:	US
Telephone Number	:	937-281-1480
Fax Number	:	937-281-1481

Provider Business Practice Location Address
First Line	:	250 SHOUP MILL RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3517
Country	:	US
Telephone Number	:	937-281-1480
Fax Number	:	937-281-1481

Authorized Official
Title or Position	:	INTERVENTION SPECIALIST
Name	:	MISS VALERIE JOHNSON
Credential	:
Telephone Number	:	937-281-1480

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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