Provider Demographics
NPI:1386036192
Name:NEW HORIZONS LEGACY
Entity Type:Organization
Organization Name:NEW HORIZONS LEGACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-832-0429
Mailing Address - Street 1:4939 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2911
Mailing Address - Country:US
Mailing Address - Phone:903-832-0429
Mailing Address - Fax:903-255-0385
Practice Address - Street 1:4939 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2911
Practice Address - Country:US
Practice Address - Phone:903-832-0429
Practice Address - Fax:903-255-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities