MEDICARE: PACIFIC HORIZONS OF CALIFORNIA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	171400000X	Health & Wellness Coach
5	171M00000X	Case Manager/Care Coordinator
6	172V00000X	Community Health Worker
7	1744G0900X	Graphics Designer
8	175T00000X	Peer Specialist
9	251B00000X	Case Management Agency
10	251E00000X	Home Health Agency
11	251S00000X	Community/Behavioral Health Agency
12	251V00000X	Voluntary or Charitable Agency
13	251X00000X	Supports Brokerage Agency
14	261QR0800X	Recovery Care Clinic/Center
15	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548072101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC HORIZONS OF CALIFORNIA

Provider Business Mailing Address
First Line	:	2108 N ST STE N
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5712
Country	:	US
Telephone Number	:	424-485-6684
Fax Number	:	424-566-9582

Provider Business Practice Location Address
First Line	:	359 REDONDO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-2656
Country	:	US
Telephone Number	:	424-485-6684
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. SCOTTY ROBERT MOORE
Credential	:
Telephone Number	:	424-485-6684

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	02/17/2025

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Directions to “PACIFIC HORIZONS OF CALIFORNIA ” Practice Location

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