Provider Demographics
NPI:1568359388
Name:OPAL HORIZONS LLC
Entity type:Organization
Organization Name:OPAL HORIZONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUND & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASSIDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUBBARTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-490-5509
Mailing Address - Street 1:7043 E EAGLE NEST WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-1239
Mailing Address - Country:US
Mailing Address - Phone:480-490-5509
Mailing Address - Fax:
Practice Address - Street 1:7043 E EAGLE NEST WAY
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-1239
Practice Address - Country:US
Practice Address - Phone:480-490-5509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health