MEDICARE: CHARLESTON TREATMENT CENTER, 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
1	261QM2800X	Methadone Clinic	02	WV
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1255349726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON TREATMENT CENTER, LLC.

Provider Business Mailing Address
First Line	:	6183 PASEO DEL NORTE, STE 200
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1155
Country	:	US
Telephone Number	:	855-259-2288
Fax Number	:	877-552-0439

Provider Business Practice Location Address
First Line	:	2157 GREENBRIER ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-9623
Country	:	US
Telephone Number	:	304-344-5924
Fax Number	:	304-344-3503

Authorized Official
Title or Position	:	VP & SECRETARY
Name	:	BRIAN PHILLIP FARLEY
Credential	:
Telephone Number	:	615-861-6000

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	11/01/2024

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