Provider Demographics
NPI:1174731053
Name:HORIZONS OF TUSCARAWAS AND CARROLL COUNTIES, INC.
Entity type:Organization
Organization Name:HORIZONS OF TUSCARAWAS AND CARROLL COUNTIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-364-5415
Mailing Address - Street 1:220 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2960
Mailing Address - Country:US
Mailing Address - Phone:330-364-5415
Mailing Address - Fax:330-364-4359
Practice Address - Street 1:10071 STATE ROUTE 212 NE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612-8780
Practice Address - Country:US
Practice Address - Phone:330-874-1060
Practice Address - Fax:330-874-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7910069320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0497476Medicaid