Provider Demographics
NPI:1912106014
Name:HORIZON RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:HORIZON RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:IKE
Authorized Official - Last Name:IKENYEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-323-0821
Mailing Address - Street 1:2100 S GREAT SOUTHWEST PKWY
Mailing Address - Street 2:SUITE 601
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3543
Mailing Address - Country:US
Mailing Address - Phone:817-323-0821
Mailing Address - Fax:
Practice Address - Street 1:2100 S GREAT SOUTHWEST PKWY
Practice Address - Street 2:SUITE 601
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3543
Practice Address - Country:US
Practice Address - Phone:817-323-0821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty