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General NPI Number Information
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NPI Number | 1215470026
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Entity Type | Organization
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Legal Business Name | BLUE HORIZON HOMES, LLC
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4340 CONQUISTA AVE.
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City | LAKEWOOD
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State | CA
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Zip | 90713
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Country | US
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Telephone | 949-381-1792
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Fax | 562-800-0318
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Provider Business Mailing Address
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Address Line | BOX # 254 12340 SEAL BEACH BLVD. SUITE B
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City | SEAL BEACH
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State | CA
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Zip | 90740
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Country | US
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Telephone | 949-381-1792
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Fax | 562-800-0318
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. IVONNE MEADER
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Credential |
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Telephone | 949-381-1792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | CA
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