Provider Demographics
NPI:1316040223
Name:SAN DIEGO TREATMENT SERVICES, LLC
Entity Type:Organization
Organization Name:SAN DIEGO TREATMENT SERVICES, LLC
Other - Org Name:THIRD AVENUE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:6183 PASEO DEL NORTE STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1151
Mailing Address - Country:US
Mailing Address - Phone:615-861-6000
Mailing Address - Fax:
Practice Address - Street 1:1155 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3136
Practice Address - Country:US
Practice Address - Phone:619-498-8260
Practice Address - Fax:619-498-8265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIA HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA10175-M261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone