Provider Demographics
NPI:1942345194
Name:BROADENING HORIZONS, INC.
Entity Type:Organization
Organization Name:BROADENING HORIZONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:606-679-1173
Mailing Address - Street 1:PO BOX 1618
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42502-1618
Mailing Address - Country:US
Mailing Address - Phone:606-679-1173
Mailing Address - Fax:606-679-1110
Practice Address - Street 1:176 ENTERPRISE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6225
Practice Address - Country:US
Practice Address - Phone:606-679-1173
Practice Address - Fax:606-679-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
KY007721970320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3300126400Medicaid