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NPI Code Detail

MEDICARE: CRC HEALTH TREATMENT CLINICS, LLC

MEDICARE: CRC HEALTH TREATMENT CLINICS, LLC
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
1207L00000XAnesthesiology Physician
2261QM2800XMethadone Clinic
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/CenterKY
4261QM2800XMethadone ClinicKY

General Provider Information

NPI Number : 1235675125
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRC HEALTH TREATMENT CLINICS, LLC
Provider Business Mailing Address
First Line : 6183 PASEO DEL NORTE, STE 200
Second Line :
City : CARLSBAD
State : CA
Zip : 92011-1155
Country : US
Telephone Number : 855-259-2288
Fax Number : 877-552-0439
Provider Business Practice Location Address
First Line : 213 MIDLAND BLVD.
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40065-7791
Country : US
Telephone Number : 502-647-0154
Fax Number : 502-633-4043
Authorized Official
Title or Position : VP & SECRETARY
Name : BRIAN PHILLIP FARLEY
Credential :
Telephone Number : 615-861-6000
Provider Enumeration Date : 01/16/2017
Last Update Date : 12/03/2024

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