Provider Demographics
NPI:1649558354
Name:HORIZON TREATMENT CENTER
Entity Type:Organization
Organization Name:HORIZON TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMALFITANO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LLMSW
Authorized Official - Phone:248-423-1728
Mailing Address - Street 1:17515 W 9 MILE RD, #720,
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4413
Mailing Address - Country:US
Mailing Address - Phone:248-423-1728
Mailing Address - Fax:
Practice Address - Street 1:17515 W 9 MILE RD STE 720
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4413
Practice Address - Country:US
Practice Address - Phone:248-423-1728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2875798251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========9OtherHORIZON TREATMENT CENTER