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	251S00000X	Community/Behavioral Health Agency
2	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1346071370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION TREATMENT CENTERS, INC.

Provider Business Mailing Address
First Line	:	6183 PASEO DEL NORTE STE 200
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1151
Country	:	US
Telephone Number	:	760-710-0968
Fax Number	:

Provider Business Practice Location Address
First Line	:	6080 S FORT APACHE RD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5616
Country	:	US
Telephone Number	:	702-703-5848
Fax Number	:

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

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	12/15/2025

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