Provider Demographics
NPI:1588023303
Name:NEW HORIZON PROVIDER SERVICES LLC
Entity Type:Organization
Organization Name:NEW HORIZON PROVIDER SERVICES LLC
Other - Org Name:NEW HORIZON PROVIDER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-615-2210
Mailing Address - Street 1:4203 GARDENDALE ST STE C204
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3174
Mailing Address - Country:US
Mailing Address - Phone:210-615-2210
Mailing Address - Fax:210-615-2216
Practice Address - Street 1:4203 GARDENDALE ST STE C204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3174
Practice Address - Country:US
Practice Address - Phone:210-615-2210
Practice Address - Fax:210-615-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016999253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care