Provider Demographics
NPI:1194969527
Name:NEW HORIZONS DISABILITY EMPOWERMENT CENTER
Entity type:Organization
Organization Name:NEW HORIZONS DISABILITY EMPOWERMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:TOONE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:928-772-1266
Mailing Address - Street 1:8085 E MANLEY DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-6154
Mailing Address - Country:US
Mailing Address - Phone:928-772-1266
Mailing Address - Fax:928-772-3808
Practice Address - Street 1:8085 E MANLEY DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-6154
Practice Address - Country:US
Practice Address - Phone:928-772-1266
Practice Address - Fax:928-772-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZROC240443171WH0202X
AZ08-00000616343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112510Medicaid