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General NPI Number Information
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NPI Number | 1053403014
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Entity Type | Organization
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Legal Business Name | CRC ED TREATMENT, INC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 1453 PASS DRIVE
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City | RENO
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State | NV
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Zip | 89509
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Country | US
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Telephone | 775-828-4949
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Fax | 775-332-3021
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Provider Business Mailing Address
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Address Line | 3740 LAKESIDE DRIVE #201
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City | RENO
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State | NV
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Zip | 89509
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Country | US
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Telephone | 775-828-4949
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Fax | 775-332-3021
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Authorized Official
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Title or Position | VP & SECRETARY
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Name | BRIAN P FARLEY
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Credential |
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Telephone | 615-861-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 101246
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 3873AGC-4
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 4718AGC-7
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License Number State | NV
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