Basic Information
| Provider Information | |||||||||
| NPI: | 1528209749 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HORIZON HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 N TARBORO ST | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276102352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197433315 | ||||||||
| FaxNumber: | 9197430580 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 NEW BERN AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276101821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192556721 | ||||||||
| FaxNumber: | 9192502949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2009 | ||||||||
| LastUpdateDate: | 03/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | MORLANDO | ||||||||
| AuthorizedOfficialFirstName: | JAQUELINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9192502939 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WAKE HEALTH SERVICES, INC | ||||||||
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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 | 344589C | 05 | NC | MEDICAID |