Provider Demographics
NPI:1306230008
Name:NEW HORIZONS PSYCHIATRIC CARE
Entity type:Organization
Organization Name:NEW HORIZONS PSYCHIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HACKBARTH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:712-338-6911
Mailing Address - Street 1:1004 21ST ST
Mailing Address - Street 2:SUITE 3 PO BOX 207
Mailing Address - City:MILFORD
Mailing Address - State:IA
Mailing Address - Zip Code:51351-7421
Mailing Address - Country:US
Mailing Address - Phone:712-338-6911
Mailing Address - Fax:712-338-6913
Practice Address - Street 1:1004 21ST ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MILFORD
Practice Address - State:IA
Practice Address - Zip Code:51351-7421
Practice Address - Country:US
Practice Address - Phone:712-338-6911
Practice Address - Fax:712-338-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG-092068302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0011650Medicaid
IA01165Medicare PIN