NPIMap

Organization Active NPI

Aegis Treatment Centers, LLC

  • Methadone Clinic
  • Manteca, CA
National Provider Identifier
1134565740
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
AEGIS TREATMENT CENTERS, LLC
Practice address
955 W. Center Street,
Suites 12a, 12B & 14
Manteca, CA 95337
Phone
(209) 239-9600
NPI assigned
May 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Authorized official

Name
Denise Winant
Title
Credentialing Supervisor
Phone
(732) 570-0268

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 39-14 CA

Addresses

Primary practice location

955 W. Center Street,
Suites 12a, 12B & 14
Manteca, CA 95337

Mailing address

1317 Route 73 Ste 200
Mount Laurel, NJ 08054-2202
Phone (856) 439-6111

Other practice location 1

955 W. Center Street, Suties 12A & 14
Manteca, CA 95337-7300
Phone (209) 463-0870

Other practice location 2

955 W Center St # 12A12B14
Manteca, CA 95337-7300
Phone (209) 239-9600

Other practice location 3

955 W Center St # 12A12B14
Manteca, CA 95337-7300
Phone (209) 239-9600

Other names 1

  • dba: Healthy Connections Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200125000215 CA Part B Supplier - Opioid Treatment Program (Otp) 2365732690 35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ontario, CA; Oxnard, CA; Pasadena, CA; Pomona, CA; Redding, CA; Redlands, CA; Roseville, CA; Santa Barbara, CA…

Other NPIs on the same Medicare enrollment 35

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 35

National Provider Directory

National Provider Directory
Tax ID family
Aegis Treatment Centers LLC78 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

955 W Center St
#12A12B14
Manteca, CA 95337
Phone (209) 239-9600

Practitioners & affiliated clinicians

Practitioners 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708041600000",
    "number": "1134565740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 ROUTE 73 STE 200",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542202",
            "telephone_number": "856-439-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 W. CENTER STREET,",
            "address_2": "SUITES 12A, 12B & 14",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "95337",
            "telephone_number": "209-239-9600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "955 W. Center Street, Suties 12A & 14",
            "address_purpose": "LOCATION",
            "city": "Manteca",
            "state": "CA",
            "postal_code": "953377300",
            "country_code": "US",
            "telephone_number": "209-463-0870",
            "fax_number": "209-463-1803",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "955 W Center St # 12A12B14",
            "address_purpose": "LOCATION",
            "city": "Manteca",
            "state": "CA",
            "postal_code": "953377300",
            "country_code": "US",
            "telephone_number": "209-239-9600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "955 W Center St # 12A12B14",
            "address_purpose": "LOCATION",
            "city": "Manteca",
            "state": "CA",
            "postal_code": "953377300",
            "country_code": "US",
            "telephone_number": "209-239-9600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AEGIS TREATMENT CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A",
        "authorized_official_last_name": "WINANT",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "732-570-0268"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CA",
            "license": "39-14",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba: Healthy Connections",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "dba: Healthy Connections",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manteca, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.