1023103272 NPI number — HORIZON HUMAN SERVICES, INC.

Table of content: (NPI 1023103272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023103272 NPI number — HORIZON HUMAN SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORIZON HUMAN SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023103272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E COTTONWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-836-1688
Provider Business Mailing Address Fax Number:
520-421-2708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 N. ARIZOLA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-421-2543
Provider Business Practice Location Address Fax Number:
520-421-1032
Provider Enumeration Date:
10/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MUDD
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
520-836-1688

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 101YP2500X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103G00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC2200X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163WP0807X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084P0804X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LP0808X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 883315 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: BH2357 . This is a "OBHL LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".