MEDICARE: SAN DIEGO TREATMENT 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
1	261QM2800X	Methadone Clinic	CA10175-M	CA

General Provider Information

NPI Number	:	1316040223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO TREATMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	6183 PASEO DEL NORTE STE 200
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1151
Country	:	US
Telephone Number	:	615-861-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 3RD AVE
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-3136
Country	:	US
Telephone Number	:	619-498-8260
Fax Number	:	619-498-8265

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	10/02/2024

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