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NPI Code Detail

MEDICARE: PARKERSBURG TREATMENT CENTER, LLC

MEDICARE: PARKERSBURG TREATMENT CENTER, 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
1261QM2800XMethadone Clinic08WV
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center1234567WV
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1396756078
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARKERSBURG TREATMENT CENTER, 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 : 184 HOLIDAY HILLS DRIVE
Second Line :
City : PARKERSBURG
State : WV
Zip : 26104-8006
Country : US
Telephone Number : 304-420-2400
Fax Number : 304-420-9014
Authorized Official
Title or Position : VP & SECRETARY
Name : BRIAN PHILLIP FARLEY
Credential :
Telephone Number : 615-861-6000
Provider Enumeration Date : 08/10/2006
Last Update Date : 08/23/2023

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