Healthcare Provider Details

I. General information

NPI: 1104046481
Provider Name (Legal Business Name): HORIZONS UNLIMITED OF SAN FRANCISCO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 POTRERO AVE
SAN FRANCISCO CA
94110-1430
US

IV. Provider business mailing address

440 POTRERO AVE
SAN FRANCISCO CA
94110-1430
US

V. Phone/Fax

Practice location:
  • Phone: 415-487-6700
  • Fax: 415-487-6724
Mailing address:
  • Phone: 415-487-6700
  • Fax: 415-487-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number380059AN
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CELINA ANNE LUCERO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 415-487-6717