Provider Demographics
NPI:1629369012
Name:NEW HORIZONS GROUP HOME
Entity Type:Organization
Organization Name:NEW HORIZONS GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-574-7239
Mailing Address - Street 1:2433 GRAY GOOSE LOOP
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7796
Mailing Address - Country:US
Mailing Address - Phone:910-574-7239
Mailing Address - Fax:
Practice Address - Street 1:3117 DYKE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2808
Practice Address - Country:US
Practice Address - Phone:910-339-4410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-026-911320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness