Provider Demographics
NPI:1245786631
Name:HORIZON CDS NETWORK LLC
Entity Type:Organization
Organization Name:HORIZON CDS NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MESHELL
Authorized Official - Middle Name:SHARANE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-761-4805
Mailing Address - Street 1:1655 CELERITY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8810
Mailing Address - Country:US
Mailing Address - Phone:314-761-4805
Mailing Address - Fax:
Practice Address - Street 1:1655 CELERITY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8810
Practice Address - Country:US
Practice Address - Phone:314-761-4805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home