1497475818 NPI number — CRC ED TREATMENT, LLC

Table of content: (NPI 1497475818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497475818 NPI number — CRC ED TREATMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRC ED TREATMENT, 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:
6
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:
1497475818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ACADIA HEALTHCARE COMPANY, INC.
Provider Second Line Business Mailing Address:
6100 TOWER CIRCLE, STE 1000
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-861-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3251 PIRAGUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92009-7840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-436-8930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2022

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 550008104 . This is a "STATE OF CA DEPARTMENT OF PUBLIC HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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