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General NPI Number Information
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NPI Number | 1255903423
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Entity Type | Organization
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Legal Business Name | CRC HEALTH TREATMENT CLINICS, LLC
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 1510 COMMERCIAL PARK DRIVE
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City | LAKELAND
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State | FL
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Zip | 33801
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Country | US
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Telephone | 863-345-8090
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Fax | 863-606-0146
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Provider Business Mailing Address
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Address Line | 6183 PASEO DEL NORTE STE 200
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City | CARLSBAD
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State | CA
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Zip | 92011-1155
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Country | US
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Telephone | 855-259-2288
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Fax |
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Authorized Official
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Title or Position | VP & SECRETARY
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Name | BRIAN PHILLIP 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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