Healthcare Provider Details

I. General information

NPI: 1811384498
Provider Name (Legal Business Name): AEGIS TREATMENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 STATE ST
SANTA BARBARA CA
93110-1848
US

IV. Provider business mailing address

4129 STATE ST
SANTA BARBARA CA
93110-1848
US

V. Phone/Fax

Practice location:
  • Phone: 805-964-4795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: KEYVAN SAFINYA
Title or Position: COUNSELOR/CASE MANAGER
Credential:
Phone: 805-403-8524