Provider Demographics
NPI:1326494543
Name:NEW HORIZONS NORTH, INC.
Entity Type:Organization
Organization Name:NEW HORIZONS NORTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-682-7171
Mailing Address - Street 1:1215 NORTH AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555
Mailing Address - Country:US
Mailing Address - Phone:715-339-6248
Mailing Address - Fax:715-339-6247
Practice Address - Street 1:1215 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555
Practice Address - Country:US
Practice Address - Phone:715-339-6248
Practice Address - Fax:715-339-6247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1061-800251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3131OtherWISCONSIN STATE CSP CERTIFICATION LINCENSE