Basic Information
Provider Information
NPI: 1992860654
EntityType: 2
ReplacementNPI:  
OrganizationName: HORIZON HOME CARE, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: 416A FAIRLEY ST
Address2:  
City: LAURINBURG
State: NC
PostalCode: 283523612
CountryCode: US
TelephoneNumber: 9102669993
FaxNumber: 9102669994
Practice Location
Address1: 416A FAIRLEY ST
Address2:  
City: LAURINBURG
State: NC
PostalCode: 283523612
CountryCode: US
TelephoneNumber: 9102669993
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/23/2006
LastUpdateDate: 06/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LOCKLEAR
AuthorizedOfficialFirstName: RADELLA
AuthorizedOfficialMiddleName: ANN
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 9102669993
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X178034NCY193400000X MULTIPLE SINGLE SPECIALTY GROUPNursing Service ProvidersRegistered Nurse 

No ID Information.


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