Provider Demographics
NPI:1932871571
Name:BLUE HORIZON PROFESSIONAL GROUP, INC
Entity Type:Organization
Organization Name:BLUE HORIZON PROFESSIONAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-337-3244
Mailing Address - Street 1:1423 SE 16TH PL STE 101
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3876
Mailing Address - Country:US
Mailing Address - Phone:239-288-6046
Mailing Address - Fax:888-388-5055
Practice Address - Street 1:1423 SE 16TH PL STE 101
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3876
Practice Address - Country:US
Practice Address - Phone:239-288-6046
Practice Address - Fax:888-388-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty