MEDICARE: HILLSIDE HORIZON FOR TEENS, LLC

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	323P00000X	Psychiatric Residential Treatment Facility
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1952047128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLSIDE HORIZON FOR TEENS, LLC

Provider Business Mailing Address
First Line	:	24195 JUANITA DR
Second Line	:
City	:	MENIFEE
State	:	CA
Zip	:	92587-9294
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24195 JUANITA DR
Second Line	:
City	:	MENIFEE
State	:	CA
Zip	:	92587-9294
Country	:	US
Telephone Number	:	855-746-8378
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NICHOLAS BEETS
Credential	:
Telephone Number	:	949-933-1931

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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