Basic Information
| Provider Information | |||||||||
| NPI: | 1376183855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW HORIZON FAMILY HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 975 W FARIS RD | ||||||||
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| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647298330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1133 PENDLETON ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647298330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2020 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | REGINA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 8647298330 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW HORIZON FAMILY HEALTH SERVICES, INC. | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.