Provider Demographics
NPI:1760685770
Name:LIVINGSTON COUNTY NEW HORIZONS
Entity Type:Organization
Organization Name:LIVINGSTON COUNTY NEW HORIZONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-646-1513
Mailing Address - Street 1:920 CLINEFELTER ST
Mailing Address - Street 2:BOX 203
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-2348
Mailing Address - Country:US
Mailing Address - Phone:660-646-1513
Mailing Address - Fax:
Practice Address - Street 1:920 CLINEFELTER ST
Practice Address - Street 2:BOX 203
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-2348
Practice Address - Country:US
Practice Address - Phone:660-646-1513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO15677681OtherMO TAX ID #