Provider Demographics
NPI:1750433728
Name:EAST CAROLINA UNIVERSITY HORIZONS
Entity type:Organization
Organization Name:EAST CAROLINA UNIVERSITY HORIZONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:SKALKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:252-328-0018
Mailing Address - Street 1:BELK ANNEX 4
Mailing Address - Street 2:ECU RCLS DEPARTMENT-ECU HORIZONS
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4353
Mailing Address - Country:US
Mailing Address - Phone:252-328-4640
Mailing Address - Fax:252-328-4642
Practice Address - Street 1:174 MINGES COLISEUM ECU RCLS DEPT.
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4353
Practice Address - Country:US
Practice Address - Phone:252-328-4640
Practice Address - Fax:252-328-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL074127251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301318Medicaid