Organization
CLUB HORIZON, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CARLISS MANAY GUNTER GUNTER MSW (EXECUTIVE DIRECTOR)
(919) 266-2202
Entity
Organization
Contact information
Practice address
101B FOREST DR, KNIGHTDALE, NC 27545-9603
(919) 266-2202
Mailing address
101B FOREST DR, KNIGHTDALE, NC 27545-9603
(919) 266-2202
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MHL 092613
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301230B
—
NC
05
—
8301230S
—
NC
Enumeration date
12/20/2006
Last updated
10/21/2008
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