Provider Demographics
NPI:1033553946
Name:PRIME HORIZON, INC.
Entity Type:Organization
Organization Name:PRIME HORIZON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-284-9656
Mailing Address - Street 1:117 N MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1819
Mailing Address - Country:US
Mailing Address - Phone:262-284-9656
Mailing Address - Fax:262-284-4590
Practice Address - Street 1:117 N MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-1819
Practice Address - Country:US
Practice Address - Phone:262-284-9656
Practice Address - Fax:262-284-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care