Provider Demographics
NPI:1073938098
Name:SUBOXONE TREATMENT AND COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:SUBOXONE TREATMENT AND COUNSELING SERVICES LLC
Other - Org Name:STACS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-576-0818
Mailing Address - Street 1:625 STEELE LANE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3127
Mailing Address - Country:US
Mailing Address - Phone:707-576-1919
Mailing Address - Fax:707-577-1852
Practice Address - Street 1:625 STEELE LANE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3127
Practice Address - Country:US
Practice Address - Phone:707-576-1919
Practice Address - Fax:707-577-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management