Provider Demographics
NPI:1093193682
Name:CRC ED TREATMENT, LLC
Entity Type:Organization
Organization Name:CRC ED TREATMENT, LLC
Other - Org Name:MONTECATINI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:2524 LA COSTA AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7321
Mailing Address - Country:US
Mailing Address - Phone:760-436-2657
Mailing Address - Fax:
Practice Address - Street 1:6183 PASEO DEL NORTE
Practice Address - Street 2:SUITE 110
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1154
Practice Address - Country:US
Practice Address - Phone:760-436-2657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA009821Medicare UPIN