Basic Information
| Provider Information | |||||||||
| NPI: | 1023034386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW HORIZON YOUTH CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40060 NATIONAL RD | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437199763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407820092 | ||||||||
| FaxNumber: | 7407821510 | ||||||||
| Practice Location | |||||||||
| Address1: | 40060 NATIONAL RD | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437199763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407820092 | ||||||||
| FaxNumber: | 7407821510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DEGARMO | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7407820092 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320600000X | 1138884 | OH | Y | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 1138884 | 01 | OH | STATE OF OHIO CERTIFICATE | OTHER |