Healthcare Provider Details

I. General information

NPI: 1063273043
Provider Name (Legal Business Name): AEGIS TREATMENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E OCEAN AVE
LOMPOC CA
93436-6829
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 805-849-2318
  • Fax:
Mailing address:
  • Phone: 732-570-0268
  • Fax: 856-581-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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