Provider Demographics
NPI:1841537511
Name:MY HORIZON, LLC
Entity type:Organization
Organization Name:MY HORIZON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JON
Authorized Official - Middle Name:BRIGGS
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:907-490-4625
Mailing Address - Street 1:2866 CIRCLE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-6707
Mailing Address - Country:US
Mailing Address - Phone:907-490-4625
Mailing Address - Fax:
Practice Address - Street 1:2866 CIRCLE LOOP RD
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-6707
Practice Address - Country:US
Practice Address - Phone:907-490-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health