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General NPI Number Information
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NPI Number | 1326313164
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Entity Type | Organization
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Legal Business Name | BALBOA HORIZONS RECOVERY SERVICES
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 129 CABRILLO ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3053
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Country | US
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Telephone | 949-515-4140
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Fax | 949-386-8331
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Provider Business Mailing Address
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Address Line | 1132 W BALBOA BLVD
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City | NEWPORT BEACH
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State | CA
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Zip | 92661-1091
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID LONGRIDGE
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Credential |
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Telephone | 949-515-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 300165AP
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License Number State | CA
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