Healthcare Provider Details

I. General information

NPI: 1194881755
Provider Name (Legal Business Name): AEGIS TREATMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/17/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14240 E. IMPERIAL HWY
LA MIRADA CA
90638-1940
US

IV. Provider business mailing address

1317 ROUTE 73 STE 200
MOUNT LAUREL NJ
08054-2202
US

V. Phone/Fax

Practice location:
  • Phone: 562-946-1587
  • Fax: 562-946-5740
Mailing address:
  • Phone: 856-439-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: DENISE WINANT
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 732-570-0268