Provider Demographics
NPI:1700227360
Name:MARION COUNTY HORIZON CENTER
Entity Type:Organization
Organization Name:MARION COUNTY HORIZON CENTER
Other - Org Name:LAKEWOOD HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:ARMBRUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-548-3278
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-0745
Mailing Address - Country:US
Mailing Address - Phone:618-548-0309
Mailing Address - Fax:618-548-3720
Practice Address - Street 1:218 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-3539
Practice Address - Country:US
Practice Address - Phone:618-548-3278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201200007M251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health