Aegis Treatment Centers, LLC
Organization Active NPI Methadone Clinic · Roseville, CA
NPI 1861558413 · NPPES record last updated Sep 17, 2023
Key facts
- NPI
- 1861558413
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- Legal business name
- AEGIS TREATMENT CENTERS, LLC
- Practice address
- 1133 Coloma Way
Suite # a, B and C
Roseville, CA 95661-4480 - Phone
- (916) 774-6647
- Fax
- (916) 774-6456
- NPI assigned
- Dec 28, 2006
- 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) 21
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
1133 Coloma Way
Ste B
Roseville, CA 95661
1133 Coloma Way
Ste A
Roseville, CA 95661
Phone (916) 774-6647
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | Yes |
Addresses
Primary practice location
1133 Coloma Way
Suite # a, B and C
Roseville, CA 95661-4480
Mailing address
1317 Route 73 Ste 200
Mount Laurel, NJ 08054-2202
Phone (856) 439-6111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HDC70085F | Medicaid | CA |
Other providers in Roseville, CA
- Adventist Health Care Network, Inc.
- Adventist Health Outpatient Pharmacy Services, LLC
- Adventist Health Physicians Network
- Adventist Health System / West
- Aegis Treatment Centers, LLC
- Affirmed Care LLC
- Affordable Counseling and Educational Serviecs
- Abhishek Agarwal
- Shawn Aghili
- Jacquelline Desiree Agramonte
All providers in Roseville, 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.