Club Horizon, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

MHL 092613 Issued in NC

Legal business name

CLUB HORIZON, INC.

Practice address

101B Forest Dr
Knightdale, NC 27545-9603

Phone

(919) 266-2202

NPI assigned

Dec 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Carliss Manay Gunter Gunter, MSW

Title

Executive Director

Phone

(919) 266-2202

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1871657346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101B FOREST DR",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275459603",
            "telephone_number": "919-266-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101B FOREST DR",
            "city": "KNIGHTDALE",
            "state": "NC",
            "postal_code": "275459603",
            "telephone_number": "919-266-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB HORIZON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "GUNTER",
        "authorized_official_first_name": "CARLISS",
        "authorized_official_middle_name": "MANAY GUNTER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "919-266-2202",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "MHL 092613",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301230B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301230S",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.