Healthcare Provider Details

I. General information

NPI: 1861906687
Provider Name (Legal Business Name): CHARLESTON TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 GREENBRIER ST
CHARLESTON WV
25311-9623
US

IV. Provider business mailing address

6183 PASEO DEL NORTE STE 200
CARLSBAD CA
92011-1155
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-5924
  • Fax: 304-344-3503
Mailing address:
  • Phone: 855-259-2288
  • Fax: 877-552-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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