Healthcare Provider Details

I. General information

NPI: 1841914033
Provider Name (Legal Business Name): HILLSIDE HORIZON FOR TEENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21811 RICHARD ST
PERRIS CA
92570-8691
US

IV. Provider business mailing address

24195 JUANITA DR
CANYON LAKE CA
92587-9294
US

V. Phone/Fax

Practice location:
  • Phone: 855-746-8378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS BEETS
Title or Position: DIRECTOR
Credential:
Phone: 949-933-1931