Aegis Treatment Centers, LLC
Organization Active NPI Methadone Clinic · Redding, CA
NPI 1760922207 · NPPES record last updated Sep 17, 2023
Key facts
- NPI
- 1760922207
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- License
- 04-02MU1 (CA)
- Legal business name
- AEGIS TREATMENT CENTERS, LLC
- Practice address
- 1137 Hartnell Avenue, Suite D & E
1129, 1133, 1135, 1141, 1145 & 1147 Hartnell Avenue
Redding, CA 96002-2113 - Phone
- (530) 345-3491
- Fax
- (530) 345-0261
- NPI assigned
- Mar 2, 2017
- Organization subpart
- No
Authorized official
- Name
- Denise Winant
- Title
- Credentialing Supervisor
- Phone
- (732) 570-0268
Other NPIs on the same Medicare enrollment 35
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Opioid treatment program
- Medicare-enrolled since Jan 1, 2020
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
National Provider Directory
- Tax ID family
- Aegis Treatment Centers LLC
Locations
1137 Hartnell Ave
Ste E
Redding, CA 96002
1137 Hartnell Ave
Ste D
Redding, CA 96002
Phone (530) 345-3491
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | 04-02MU1 | CA | Yes |
Addresses
Primary practice location
1137 Hartnell Avenue, Suite D & E
1129, 1133, 1135, 1141, 1145 & 1147 Hartnell Avenue
Redding, CA 96002-2113
Mailing address
1317 Route 73 Ste 200
Mount Laurel, NJ 08054-2202
Phone (856) 439-6111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04-02MU1 | Other | CA | CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES - NTP LICENSE |
| CA10,297 | Other | CA | CSAT |
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All providers in Redding, CA · Methadone Clinic in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.