Healthcare Provider Details

I. General information

NPI: 1093193682
Provider Name (Legal Business Name): CRC ED TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6183 PASEO DEL NORTE SUITE 110
CARLSBAD CA
92011-1154
US

IV. Provider business mailing address

2524 LA COSTA AVE
CARLSBAD CA
92009-7321
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-2657
  • Fax:
Mailing address:
  • Phone: 760-436-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN P FARLEY
Title or Position: VICE PRESIDENT AND SECRETARY
Credential:
Phone: 615-861-6000