Basic Information
| Provider Information | |||||||||
| NPI: | 1184808008 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW HORIZON FAMILY HEALTH SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NEW HORIZON FAMILY HEALTH SERV. - SLATER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 287 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296020287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643126001 | ||||||||
| FaxNumber: | 8642332618 | ||||||||
| Practice Location | |||||||||
| Address1: | 1588 GEER HWY | ||||||||
| Address2: | |||||||||
| City: | TRAVELERS REST | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296909204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648361109 | ||||||||
| FaxNumber: | 8648366365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | REGINA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8643126001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW HORIZON FAMILY HEALTH SERVICES, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FQC067 | 05 | SC | MEDICAID |