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NPI Code Detail

MEDICARE: AEGIS TREATMENT CENTERS, LLC

MEDICARE: AEGIS TREATMENT CENTERS, 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 Clinic

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760544456
Entity Type Code : Organization
Provider Name (Legal Business Name) : AEGIS TREATMENT CENTERS, LLC
Provider Business Mailing Address
First Line : 1317 ROUTE 73 STE 200
Second Line :
City : MOUNT LAUREL
State : NJ
Zip : 08054-2202
Country : US
Telephone Number : 856-439-6111
Fax Number :
Provider Business Practice Location Address
First Line : 11041 VALLEY BLVD
Second Line :
City : EL MONTE
State : CA
Zip : 91731-2516
Country : US
Telephone Number : 626-442-4177
Fax Number : 626-442-4498
Authorized Official
Title or Position : CREDENTIALING SUPERVISOR
Name : DENISE WINANT
Credential :
Telephone Number : 732-570-0268
Provider Enumeration Date : 12/15/2006
Last Update Date : 09/17/2023

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Directions to “AEGIS TREATMENT CENTERS, LLC ” Practice Location

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