MEDICARE: BALBOA HORIZONS RECOVERY SERVICES LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility	300165AP	CA

General Provider Information

NPI Number	:	1194921270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALBOA HORIZONS RECOVERY SERVICES LP

Provider Business Mailing Address
First Line	:	1132 W BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1091
Country	:	US
Telephone Number	:	949-675-3406
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 W BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1091
Country	:	US
Telephone Number	:	949-675-3406
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS DEVELOPMENT CO-OWNER
Name	:	MR. MATHIAS WILLIAM ARNOLD HANCK
Credential	:
Telephone Number	:	714-801-1839

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	08/22/2020

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