Healthcare Provider Details

I. General information

NPI: 1902405749
Provider Name (Legal Business Name): CRC HEALTH TREATMENT CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4553 WATKINS STREET
PACE FL
32571-2511
US

IV. Provider business mailing address

PO BOX 682669
FRANKLIN TN
37068-2669
US

V. Phone/Fax

Practice location:
  • Phone: 904-438-7640
  • Fax: 904-438-7656
Mailing address:
  • Phone: 760-710-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: BRIAN PHILLIP FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-716-9335