1255349445 NPI number — HUNTINGTON TREATMENT CENTER, LLC

Table of content: (NPI 1255349445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255349445 NPI number — HUNTINGTON TREATMENT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGTON TREATMENT CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255349445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6183 PASEO DEL NORTE, STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARISBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92011-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-259-2288
Provider Business Mailing Address Fax Number:
877-552-0439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-525-5691
Provider Business Practice Location Address Fax Number:
304-525-5693
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARLEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
PHILLIP
Authorized Official Title or Position:
VP & SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2800X , with the licence number: 04 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04 . This is a "OPIOID TREATMENT PROGRAM" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com