1679798219 NPI number — HORIZONS BEHAVORIAL HEALTH SOLUTIONS,INC

Table of content: (NPI 1679798219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679798219 NPI number — HORIZONS BEHAVORIAL HEALTH SOLUTIONS,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORIZONS BEHAVORIAL HEALTH SOLUTIONS,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:
1679798219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7814
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GURNEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60031-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-948-1000
Provider Business Mailing Address Fax Number:
262-943-9374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6123 GREEN BAY RD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53142-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-948-1000
Provider Business Practice Location Address Fax Number:
262-942-9374
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAO
Authorized Official First Name:
KALPANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
262-948-1000

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , 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: 05632021 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 39655400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 249940000 . This is a "MAGELLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 36449357010 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 249940000 . This is a "MAILHANDLERS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 6110476 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 352866678001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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