Provider Demographics
NPI:1699073692
Name:HORIZON HOUSE DELAWARE INC
Entity type:Organization
Organization Name:HORIZON HOUSE DELAWARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WJ
Authorized Official - Last Name:WILUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-386-3838
Mailing Address - Street 1:417 E MAIN ST
Mailing Address - Street 2:ASHLEY PLAZA
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1463
Mailing Address - Country:US
Mailing Address - Phone:302-449-3246
Mailing Address - Fax:302-449-2198
Practice Address - Street 1:417 E MAIN ST
Practice Address - Street 2:ASHLEY PLAZA
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-1463
Practice Address - Country:US
Practice Address - Phone:302-449-3246
Practice Address - Fax:302-449-2198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORIZON HOUSE DELAWARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE609002251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPTAN 732100Medicare UPIN