Clarksburg Treatment Center, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

CLARKSBURG TREATMENT CENTER, LLC

Practice address

706 Oakmound Rd
Clarksburg, WV 26301-9398

Phone

(304) 622-7511

Fax

(304) 622-6856

NPI assigned

Aug 31, 2006

Organization subpart

Yes

Parent organization

ACADIA HEALTHCARE COMPANY, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian Phillip Farley

Title

VP & Secretary

Phone

(615) 861-6000

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Clarksburg Treatment Center, LLC

  • Methadone Clinic
  • Clarksburg, WV
  • NPI 1124533930

  9931534245

  Same PAC ID

Tax ID family

Clarksburg Treatment Center LLC3 organizations share this tax ID, including this one

Part of

Haven Behavioral Healthcare

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Clarksburg Treatment Center, LLC

  • Methadone Clinic
  • Clarksburg, WV
  • NPI 1124533930
  NPD tax ID
• Clarksburg Treatment Center, LLC

  • Methadone Clinic
  • Clarksburg, WV
  • NPI 1619379559
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward P Brennan II, DO

  • Family Medicine Physician
  • Grafton, WV
  • NPI 1316117815
  Medicare reassignment NPD
• Erika Anne Pallie, M.D.

  • Addiction Medicine (Family Medicine) Physician
  • Morgantown, WV
  • NPI 1134144553
  NPD (past)
• Stephanie C Eken Sander, MD

  • Child & Adolescent Psychiatry Physician
  • Franklin, TN
  • NPI 1558558270
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1013029156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6183 PASEO DEL NORTE, STE 200",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920111155",
            "telephone_number": "855-259-2288",
            "fax_number": "877-552-0439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 OAKMOUND RD",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263019398",
            "telephone_number": "304-622-7511",
            "fax_number": "304-622-6856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSBURG TREATMENT CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ACADIA HEALTHCARE COMPANY, INC.",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "FARLEY",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "PHILLIP",
        "authorized_official_title_or_position": "VP & SECRETARY",
        "authorized_official_telephone_number": "615-861-6000"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "WV",
            "license": "03",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rose M Clark, NP
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• Clarksburg Treatment Center, LLC
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• Clarksburg Vamc

• Mental Health Clinic/Center (Including Community Mental Health Center) in Clarksburg, WV
• Providers in Clarksburg, WV by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.