Provider Demographics
NPI:1710522289
Name:HORIZON ON GRANADA, LLC
Entity Type:Organization
Organization Name:HORIZON ON GRANADA, LLC
Other - Org Name:PLEASANT HILL FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-334-6169
Mailing Address - Street 1:1653 REGAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6644
Mailing Address - Country:US
Mailing Address - Phone:407-334-6169
Mailing Address - Fax:407-350-4613
Practice Address - Street 1:1653 REGAL OAK DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-6644
Practice Address - Country:US
Practice Address - Phone:407-334-6169
Practice Address - Fax:407-350-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care