Provider Demographics
NPI:1316046956
Name:HORIZONS CENTER FOR INDEPENDENT LIVING INC.
Entity type:Organization
Organization Name:HORIZONS CENTER FOR INDEPENDENT LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-295-7546
Mailing Address - Street 1:934 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4851
Mailing Address - Country:US
Mailing Address - Phone:304-428-7799
Mailing Address - Fax:304-428-7766
Practice Address - Street 1:934 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4851
Practice Address - Country:US
Practice Address - Phone:304-428-7799
Practice Address - Fax:304-428-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023335002Medicaid