Provider Demographics
NPI:1023034386
Name:NEW HORIZON YOUTH CENTER LLC
Entity Type:Organization
Organization Name:NEW HORIZON YOUTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEGARMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-782-0092
Mailing Address - Street 1:40060 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:OH
Mailing Address - Zip Code:43719-9763
Mailing Address - Country:US
Mailing Address - Phone:740-782-0092
Mailing Address - Fax:740-782-1510
Practice Address - Street 1:40060 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:OH
Practice Address - Zip Code:43719-9763
Practice Address - Country:US
Practice Address - Phone:740-782-0092
Practice Address - Fax:740-782-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1138884320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1138884OtherSTATE OF OHIO CERTIFICATE