Basic Information
| Provider Information | |||||||||
| NPI: | 1326698887 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AEGIS TREATMENT CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7246 REMMET AVE | ||||||||
| Address2: | |||||||||
| City: | CANOGA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913031531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008210775 | ||||||||
| FaxNumber: | 8182060379 | ||||||||
| Practice Location | |||||||||
| Address1: | 2107, 2109 & 2113 1ST ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955010840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008210775 | ||||||||
| FaxNumber: | 8182060379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2019 | ||||||||
| LastUpdateDate: | 04/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | VO | ||||||||
| AuthorizedOfficialFirstName: | THAIPHONG | ||||||||
| AuthorizedOfficialMiddleName: | THANH | ||||||||
| AuthorizedOfficialTitleorPosition: | IN-HOUSE COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 8182060360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.