Basic Information
| Provider Information | |||||||||
| NPI: | 1609094333 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW HORIZONS CSB CENTRAL ACCESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 COMER AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319048725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063230174 | ||||||||
| FaxNumber: | 7062563264 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 COMER AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319048725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063230174 | ||||||||
| FaxNumber: | 7062563264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 08/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | ALEXANDER | ||||||||
| AuthorizedOfficialFirstName: | PERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7065965582 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW HORIZONS COMMUNTIY SERVICE BOARD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 000601565C | 05 | GA | MEDICAID |