Provider Demographics
NPI:1104171248
Name:HORIZON COMMUNITY LIVING
Entity type:Organization
Organization Name:HORIZON COMMUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:806-790-5818
Mailing Address - Street 1:3021 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1425
Mailing Address - Country:US
Mailing Address - Phone:806-790-5818
Mailing Address - Fax:806-368-7383
Practice Address - Street 1:3021 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1425
Practice Address - Country:US
Practice Address - Phone:806-790-5818
Practice Address - Fax:806-368-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health