1538356977 NPI number — NEW HORIZONS NORTH, INC.

Table of content: (NPI 1538356977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538356977 NPI number — NEW HORIZONS NORTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HORIZONS NORTH, 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:
1538356977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 MAIN ST W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54806-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-682-7171
Provider Business Mailing Address Fax Number:
715-682-7176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W BAYFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHBURN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54891-1131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-373-5505
Provider Business Practice Location Address Fax Number:
715-373-2203
Provider Enumeration Date:
10/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FELTY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
715-682-7171

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  1061-800 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 43423800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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