Basic Information
| Provider Information | |||||||||
| NPI: | 1255903423 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRC HEALTH TREATMENT CLINICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6183 PASCO DEL NORTE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920111155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552592288 | ||||||||
| FaxNumber: | 8775520439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1510 COMMERCIAL PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048915900 | ||||||||
| FaxNumber: | 8775520439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2021 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | SANDERSON | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6158616000 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ACADIA HEALTHCARE COMPANY, INC | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.