=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104046481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HORIZONS UNLIMITED OF SAN FRANCISCO, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2007
-----------------------------------------------------
Last Update Date | 08/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 POTRERO AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-487-6700
-----------------------------------------------------
Fax | 415-487-6724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 POTRERO AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94110-1430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-487-6700
-----------------------------------------------------
Fax | 415-487-6724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | CELINA ANNE LUCERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-487-6717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 380059AN
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3245S0500X
-----------------------------------------------------
Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------