Aegis Treatment Centers, LLC
Organization Active NPI Methadone Clinic · Redlands, CA
NPI 1992219646 · NPPES record last updated Sep 17, 2023
Key facts
- NPI
- 1992219646
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- Legal business name
- AEGIS TREATMENT CENTERS, LLC
- Practice address
- 1889 W Redlands Blvd BLDG 9
Redlands, CA 92373-3119 - Phone
- (909) 501-5167
- Fax
- (909) 501-5167
- NPI assigned
- Nov 16, 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) 13
Practitioners 23
-
Kimberly Elyse Conley, M.D.
-
Monica M Cundiff, PSS
-
Sylvia Mellisa Hernandez, CADCII ICADC
-
Trask Robert Hernandez, CADCII
-
Jennifer Lynnette Labelle, SUDCC
-
Ashley Josselyn Moore, BA PSYCHOLOGY
-
Robert Michael Schehr, LMFT
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2144759 | Aegis Treatment Centers, LLC | Certificate of waiver | Feb 21, 2028 |
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
1889 W Redlands Blvd
Bldg 9
Redlands, CA 92373
Phone (909) 501-5165
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | Yes |
Addresses
Primary practice location
1889 W Redlands Blvd BLDG 9
Redlands, CA 92373-3119
Mailing address
1317 Route 73 Ste 200
Mount Laurel, NJ 08054-2202
Phone (856) 439-6111
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All providers in Redlands, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.