Provider Demographics
NPI:1225760069
Name:AEGIS TREATMENT CENTERS, LLC
Entity Type:Organization
Organization Name:AEGIS TREATMENT CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-570-0268
Mailing Address - Street 1:7246 REMMET AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1531
Mailing Address - Country:US
Mailing Address - Phone:818-206-0360
Mailing Address - Fax:
Practice Address - Street 1:222 E MAIN ST STE 102&103
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2361
Practice Address - Country:US
Practice Address - Phone:760-956-2462
Practice Address - Fax:760-956-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone