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NPI Code Detail

MEDICARE: SUBOXONE TREATMENT AND COUNSELING SERVICES LLC

MEDICARE: SUBOXONE TREATMENT AND COUNSELING SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency

General Provider Information

NPI Number : 1073938098
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUBOXONE TREATMENT AND COUNSELING SERVICES LLC
Provider Business Mailing Address
First Line : 625 STEELE LANE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-3127
Country : US
Telephone Number : 707-576-1919
Fax Number : 707-577-1852
Provider Business Practice Location Address
First Line : 625 STEELE LANE
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-3127
Country : US
Telephone Number : 707-576-1919
Fax Number : 707-577-1852
Authorized Official
Title or Position : PRESIDENT
Name : MR. LEE R TILLMAN
Credential :
Telephone Number : 707-576-0818
Provider Enumeration Date : 02/27/2014
Last Update Date : 08/30/2023

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Directions to “SUBOXONE TREATMENT AND COUNSELING SERVICES LLC ” Practice Location

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