Provider Demographics
NPI:1881003739
Name:HORIZON RIDGE CLINIC LLC
Entity Type:Organization
Organization Name:HORIZON RIDGE CLINIC LLC
Other - Org Name:VANN-EDDINS CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDDINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:702-489-2889
Mailing Address - Street 1:1670 E FLAMINGO RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5120
Mailing Address - Country:US
Mailing Address - Phone:702-489-2889
Mailing Address - Fax:702-780-0755
Practice Address - Street 1:1670 E FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5120
Practice Address - Country:US
Practice Address - Phone:702-489-2889
Practice Address - Fax:702-780-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
NV251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250004428Medicaid