Provider Demographics
NPI:1194921270
Name:BALBOA HORIZONS RECOVERY SERVICES LP
Entity type:Organization
Organization Name:BALBOA HORIZONS RECOVERY SERVICES LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATHIAS WILLIAM
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:HANCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-801-1839
Mailing Address - Street 1:1132 W BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92661-1091
Mailing Address - Country:US
Mailing Address - Phone:949-675-3406
Mailing Address - Fax:
Practice Address - Street 1:1132 W BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92661-1091
Practice Address - Country:US
Practice Address - Phone:949-675-3406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300165AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility