MEDICARE: MISSION TREATMENT CENTERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2800X	Methadone Clinic
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154748127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION TREATMENT CENTERS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 682669
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-2669
Country	:	US
Telephone Number	:	760-710-0819
Fax Number	:

Provider Business Practice Location Address
First Line	:	1536 N. BOULDER HIGHWAY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011
Country	:	US
Telephone Number	:	702-558-8600
Fax Number	:	702-558-8700

Authorized Official
Title or Position	:	VP & SECRETARY
Name	:	BRIAN PHILLIP FARLEY
Credential	:
Telephone Number	:	615-716-9335

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	01/12/2026

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