Provider Demographics
NPI:1346367950
Name:MANITOU HORIZONS LLC
Entity Type:Organization
Organization Name:MANITOU HORIZONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-870-0878
Mailing Address - Street 1:1001 COOPER POINT RD SW
Mailing Address - Street 2:SUITE 140-341
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1107
Mailing Address - Country:US
Mailing Address - Phone:360-870-0878
Mailing Address - Fax:
Practice Address - Street 1:4412 PACIFIC AVE SE
Practice Address - Street 2:SUITE # 202
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1119
Practice Address - Country:US
Practice Address - Phone:360-870-0878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013615171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0162249OtherL & I