NPIMap

Organization Active NPI

Aegis Treatment Centers, LLC

  • Methadone Clinic
  • Inglewood, CA
National Provider Identifier
1679635361
Registry record updated Sep 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
AEGIS TREATMENT CENTERS, LLC
Practice address
614 West Manchester Boulevard, Suite 104
Suite # 104
Inglewood, CA 90301-1656
Phone
(310) 412-0879
Fax
(310) 412-3365
NPI assigned
Dec 15, 2006
Last updated
Sep 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2023

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X NU Primary

Addresses

Primary practice location

614 West Manchester Boulevard, Suite 104
Suite # 104
Inglewood, CA 90301-1656

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
HDC70073FMedicaidCA

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

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694908800000",
    "number": "1679635361",
    "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": "614 WEST MANCHESTER BOULEVARD, SUITE 104",
            "address_2": "SUITE # 104",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011656",
            "telephone_number": "310-412-0879",
            "fax_number": "310-412-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEGIS TREATMENT CENTERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2023-09-17",
        "certification_date": "2023-09-17",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HDC70073F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2023; 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.