Healthcare Provider Details

I. General information

NPI: 1386888279
Provider Name (Legal Business Name): HABIT OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HIGHWAY 35 SUITE 7
CLIFFWOOD NJ
07721-1515
US

IV. Provider business mailing address

6183 PASEO DEL NORTE STE 200
CARLSBAD CA
92011-1151
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-2555
  • Fax: 737-727-0255
Mailing address:
  • Phone: 855-259-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2000337
License Number StateNJ
# 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: 615-861-6000