Active NPI
Horizon Healthcare, Inc
- Mental Health Counselor
- Port Washington, WI
National Provider Identifier
1013931625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Legal business name
- HORIZON HEALTHCARE, INC
- Practice address
- 101 E. Pier Street
Port Washington, WI 53074-2242 - Phone
- (262) 284-3117
- Fax
- (262) 284-3087
- NPI assigned
- Jul 27, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Darren Matavka
- Title
- Vice President
- Phone
- (262) 641-9050
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
101 E. Pier Street
Port Washington, WI 53074-2242
Mailing address
285 N Janacek Rd
Brookfield, WI 53045-6102
Phone (262) 641-9050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42226900 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040124000318 | WI | Part B Supplier - Clinic/Group Practice | 0749182160 |
Receives reassigned benefits from 21 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Milwaukee, WI; Waukesha, WI; Racine, WI; Kenosha, WI |
Other NPIs on the same Medicare enrollment 12
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Addiction (Substance Use Disorder) Counselor
- Waukesha, WI
- NPI 1760408876
O20040124000318
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1361232000000",
"number": "1013931625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "285 N JANACEK RD",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530456102",
"telephone_number": "262-641-9050",
"fax_number": "262-641-9126"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 E. PIER STREET",
"city": "PORT WASHINGTON",
"state": "WI",
"postal_code": "530742242",
"telephone_number": "262-284-3117",
"fax_number": "262-284-3087"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HORIZON HEALTHCARE, INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-27",
"last_updated": "2013-02-19",
"status": "A",
"authorized_official_last_name": "MATAVKA",
"authorized_official_first_name": "DARREN",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "262-641-9050"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42226900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Washington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.