Active NPI
Aegis Treatment Centers, LLC
- Methadone Clinic
- Wilmington, CA
National Provider Identifier
1972669257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Methadone Clinic
- Legal business name
- AEGIS TREATMENT CENTERS, LLC
- Practice address
- 909 N Avalon Blvd
Wilmington, CA 90744-4503 - Phone
- (310) 513-1300
- Fax
- (310) 513-1311
- NPI assigned
- Dec 29, 2006
- Last updated
- Sep 18, 2023
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | Primary |
Addresses
Primary practice location
909 N Avalon Blvd
Wilmington, CA 90744-4503
Mailing address
1317 Route 73 Ste 200
Mount Laurel, NJ 08054-2202
Phone (856) 439-6111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HDC70093F | Medicaid | CA |
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 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… |
Other NPIs on the same Medicare enrollment 35
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba dba: Healthy Connections
- Methadone Clinic
- Manteca, CA
- NPI 1134565740
O20200125000215
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1694995200000",
"number": "1972669257",
"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": "909 N AVALON BLVD",
"city": "WILMINGTON",
"state": "CA",
"postal_code": "907444503",
"telephone_number": "310-513-1300",
"fax_number": "310-513-1311"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AEGIS TREATMENT CENTERS, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-29",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"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
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "HDC70093F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, CA
- Andrea C Adams, CAS-RAS
- Christopher Ray Adams, D.C.
- Dorcas Adeyosola Adeoye Showole, R.N.
- Advance Bariatric Center, Medical Corporation
- Aegis Treatment Centers, LLC
- Agile Occupational Medicine, PC
- Yemi Kayode Akinwole, DNP
- Alfa Farmacia
- Align Health Center Adams and Main Chiropractic
- Alliance Behavioral Health
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.