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NPI Code Detail

MEDICARE: AEGIS TREATMENT CENTERS, LLC

MEDICARE: AEGIS TREATMENT CENTERS, 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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center39-12CA
2261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1851444376
Entity Type Code : Organization
Provider Name (Legal Business Name) : AEGIS TREATMENT CENTERS, LLC
Provider Business Mailing Address
First Line : 1317 ROUTE 73 STE 200
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-2202
Country : US
Telephone Number : 856-439-6111
Fax Number :
Provider Business Practice Location Address
First Line : 1839 S. EL DORADO STREET
Second Line :
City : STOCKTON
State : CA
Zip : 95206-2025
Country : US
Telephone Number : 209-463-0870
Fax Number : 209-463-0560
Authorized Official
Title or Position : CREDENTIALING SUPERVISOR
Name : DENISE WINANT
Credential :
Telephone Number : 732-570-0268
Provider Enumeration Date : 01/19/2007
Last Update Date : 02/16/2024

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Directions to “AEGIS TREATMENT CENTERS, LLC ” Practice Location

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