Provider Demographics
NPI:1043234628
Name:HORIZON HEALTHCARE, INC
Entity Type:Organization
Organization Name:HORIZON HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATAVKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-641-9050
Mailing Address - Street 1:285 N JANACEK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6102
Mailing Address - Country:US
Mailing Address - Phone:262-641-9050
Mailing Address - Fax:262-641-9126
Practice Address - Street 1:4325 S 60TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3508
Practice Address - Country:US
Practice Address - Phone:414-546-0467
Practice Address - Fax:414-546-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42211400Medicaid
WI42160600Medicaid
WI42211421Medicaid
WI84330Medicare UPIN