Provider Demographics
NPI:1144487539
Name:NEW HORIZONS GROUP HOMES, INC.
Entity type:Organization
Organization Name:NEW HORIZONS GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE/BILLING AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-681-3968
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-0963
Mailing Address - Country:US
Mailing Address - Phone:813-571-2690
Mailing Address - Fax:813-643-6008
Practice Address - Street 1:109 E CLAY AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-3732
Practice Address - Country:US
Practice Address - Phone:813-571-2690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9058251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680153696Medicaid