Provider Demographics
NPI:1770601296
Name:HORIZON HEALTHCARE
Entity type:Organization
Organization Name:HORIZON HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-228-5940
Mailing Address - Street 1:185 STAFFORD UMBERGER RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4439
Mailing Address - Country:US
Mailing Address - Phone:276-228-5940
Mailing Address - Fax:276-228-9292
Practice Address - Street 1:185 STAFFORD UMBERGER RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4439
Practice Address - Country:US
Practice Address - Phone:276-228-5940
Practice Address - Fax:276-228-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVM005592113336L0003X
NC081703336L0003X
TN00000039033336L0003X
VA02010031653336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4827967Medicaid
TN4827967Medicaid
VA4827967OtherNCPDP
VA=========OtherTAX ID