Provider Demographics
NPI:1942433487
Name:EXPANDING HORIZONS HUMAN SERVICES, LLC
Entity Type:Organization
Organization Name:EXPANDING HORIZONS HUMAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-414-1168
Mailing Address - Street 1:3550 MORNING MIST RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6268
Mailing Address - Country:US
Mailing Address - Phone:336-414-1168
Mailing Address - Fax:
Practice Address - Street 1:1101 TYVOLA RD STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3515
Practice Address - Country:US
Practice Address - Phone:336-414-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health