Provider Demographics
NPI:1629181904
Name:HORIZON HEALTH CARE INC
Entity Type:Organization
Organization Name:HORIZON HEALTH CARE INC
Other - Org Name:LAKE PRESTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENGENHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-772-4525
Mailing Address - Street 1:709 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:LAKE PRESTON
Mailing Address - State:SD
Mailing Address - Zip Code:57249-2116
Mailing Address - Country:US
Mailing Address - Phone:605-847-4484
Mailing Address - Fax:
Practice Address - Street 1:709 4TH ST SE
Practice Address - Street 2:
Practice Address - City:LAKE PRESTON
Practice Address - State:SD
Practice Address - Zip Code:57249-2116
Practice Address - Country:US
Practice Address - Phone:605-847-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350030Medicaid
SDS4406Medicare PIN
SD5350030Medicaid