Provider Demographics
NPI:1700948999
Name:NEW HORIZONS DEVELOPMENTAL CTR INC
Entity type:Organization
Organization Name:NEW HORIZONS DEVELOPMENTAL CTR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-648-2379
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:CARRIZOZO
Mailing Address - State:NM
Mailing Address - Zip Code:88301
Mailing Address - Country:US
Mailing Address - Phone:505-648-2379
Mailing Address - Fax:505-648-2370
Practice Address - Street 1:810 E AVE
Practice Address - Street 2:
Practice Address - City:CARRIZOZO
Practice Address - State:NM
Practice Address - Zip Code:88301
Practice Address - Country:US
Practice Address - Phone:505-648-2379
Practice Address - Fax:505-648-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5085 CASA DEL SOL315P00000X
NM5086 CASA LINDA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMM6029Medicaid
NMM4388Medicaid