MEDICARE: PACIFIC BEACH HEALTH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility
3	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1871160408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC BEACH HEALTH, LLC

Provider Business Mailing Address
First Line	:	2108 GARNET AVE STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3671
Country	:	US
Telephone Number	:	858-717-4322
Fax Number	:

Provider Business Practice Location Address
First Line	:	2108 GARNET AVE STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3671
Country	:	US
Telephone Number	:	858-717-4322
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS HATHORN
Credential	:
Telephone Number	:	858-717-4322

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	05/02/2024

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Directions to “PACIFIC BEACH HEALTH, LLC ” Practice Location

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