Provider Demographics
NPI:1164641601
Name:NEW HORIZONS GROUP HOME
Entity Type:Organization
Organization Name:NEW HORIZONS GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:D P
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-574-7239
Mailing Address - Street 1:2433 GRAY GOOSE LOOP
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7796
Mailing Address - Country:US
Mailing Address - Phone:910-425-7424
Mailing Address - Fax:
Practice Address - Street 1:3319 AUBURN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-9353
Practice Address - Country:US
Practice Address - Phone:910-425-5725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-835310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness