Provider Demographics
NPI:1437712361
Name:HORTON, RICHARD LOUIS (INDIVIDUAL)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LOUIS
Last Name:HORTON
Suffix:
Gender:M
Credentials:INDIVIDUAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 E CANFIELD ST APT 207
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4602
Mailing Address - Country:US
Mailing Address - Phone:313-656-4648
Mailing Address - Fax:
Practice Address - Street 1:1331 E CANFIELD ST APT 207
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4602
Practice Address - Country:US
Practice Address - Phone:313-656-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI635738549334OtherSON
MIH635738549334OtherSON