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NPI Code Detail

MEDICARE: SOUTHERN INDIANA TREATMENT CENTER, LLC

MEDICARE: SOUTHERN INDIANA 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
1261Q00000XClinic/Center1076-0-ASRIN
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center1076-0-ASRIN
3261QM2800XMethadone Clinic1076-0-ASRIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932253812
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN INDIANA TREATMENT CENTER, LLC
Provider Business Mailing Address
First Line : PO BOX 682669
Second Line :
City : FRANKLIN
State : TN
Zip : 37068-2669
Country : US
Telephone Number : 760-710-0819
Fax Number :
Provider Business Practice Location Address
First Line : 7509 CHARLESTOWN PIKE
Second Line :
City : CHARLESTOWN
State : IN
Zip : 47111-9623
Country : US
Telephone Number : 812-256-4686
Fax Number : 812-256-4415
Authorized Official
Title or Position : VP & SECRETARY
Name : BRIAN PHILLIP FARLEY
Credential :
Telephone Number : 615-861-6000
Provider Enumeration Date : 01/22/2007
Last Update Date : 04/07/2026

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Directions to “SOUTHERN INDIANA TREATMENT CENTER, LLC ” Practice Location

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