Healthcare Provider Details

I. General information

NPI: 1538208566
Provider Name (Legal Business Name): GALAX TREATMENT CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 LARKSPUR LN
GALAX VA
24333-2305
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 276-236-2994
  • Fax: 276-236-4802
Mailing address:
  • Phone: 615-861-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number617-06-001
License Number StateVA

VIII. Authorized Official

Name: BRIAN PHILLIP FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000