Provider Demographics
NPI:1700305679
Name:HORIZON MEDICAL TREATMENT CENTERS
Entity Type:Organization
Organization Name:HORIZON MEDICAL TREATMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMIN DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:COVINGTON
Authorized Official - Last Name:GUILBAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-636-2910
Mailing Address - Street 1:4313 BLUEBONNET BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9679
Mailing Address - Country:US
Mailing Address - Phone:225-636-2910
Mailing Address - Fax:225-636-5227
Practice Address - Street 1:4313 BLUEBONNET BLVD STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9679
Practice Address - Country:US
Practice Address - Phone:225-636-2910
Practice Address - Fax:225-636-5227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA304510207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty