Healthcare Provider Details

I. General information

NPI: 1740105592
Provider Name (Legal Business Name): HILLSIDE HORIZON FOR TEENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23172 PLAZA POINTE DR STE 155
LAGUNA HILLS CA
92653-0101
US

IV. Provider business mailing address

27800 MOUNT SHASTA WAY
YORBA LINDA CA
92887-4241
US

V. Phone/Fax

Practice location:
  • Phone: 951-441-3133
  • Fax:
Mailing address:
  • Phone: 951-441-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS BEETS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 951-441-3133