| Blue Horizon Professional Group, Inc | |
|
1591 Hayley Ln Ste 101 Fort Myers FL 33907-2121 | |
| (239) 288-6046 | |
| (888) 388-5055 |
| Full Name | Blue Horizon Professional Group, Inc |
|---|---|
| Speciality | Assistant Behavior Analyst |
| Location | 1591 Hayley Ln Ste 101, Fort Myers, Florida |
| Authorized Official Name and Position | Rolando Davila (CEO) |
| Authorized Official Contact | 2392886046 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Horizon Professional Group, Inc 1591 Hayley Ln Fort Myers FL 33907-2121 Ph: (239) 288-6046 | Blue Horizon Professional Group, Inc 1591 Hayley Ln Ste 101 Fort Myers FL 33907-2121 Ph: (239) 288-6046 |
| NPI Number | 1508323684 |
|---|---|
| Provider Enumeration Date | 02/26/2019 |
| Last Update Date | 11/18/2020 |
| Certification Date | 11/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508323684 | NPI | - | NPPES |
| 1568930915 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106E00000X | Assistant Behavior Analyst | (* (Not Available)) | Primary |
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