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General NPI Number Information
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NPI Number | 1851444376
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Entity Type | Organization
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Legal Business Name | AEGIS TREATMENT CENTERS, LLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 1839 S. EL DORADO STREET
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City | STOCKTON
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State | CA
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Zip | 95206-2025
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Country | US
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Telephone | 209-463-0870
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Fax | 209-463-0560
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Provider Business Mailing Address
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Address Line | 1317 ROUTE 73 STE 200
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-2202
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Country | US
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Telephone | 856-439-6111
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | DENISE WINANT
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Credential |
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Telephone | 732-570-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 39-12
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License Number State | CA
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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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