Provider Demographics
NPI:1215470026
Name:BLUE HORIZON HOMES, LLC
Entity type:Organization
Organization Name:BLUE HORIZON HOMES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-381-1792
Mailing Address - Street 1:BOX # 254
Mailing Address - Street 2:12340 SEAL BEACH BLVD. SUITE B
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:949-381-1792
Mailing Address - Fax:562-800-0318
Practice Address - Street 1:4340 CONQUISTA AVE.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713
Practice Address - Country:US
Practice Address - Phone:949-381-1792
Practice Address - Fax:562-800-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities