Provider Demographics
NPI:1477869089
Name:MISSION TREATMENT CENTERS, INC.
Entity Type:Organization
Organization Name:MISSION TREATMENT CENTERS, INC.
Other - Org Name:
Other - Org Type:
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:92011-1155
Mailing Address - Country:US
Mailing Address - Phone:855-259-2288
Mailing Address - Fax:877-552-0439
Practice Address - Street 1:1737 LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5037
Practice Address - Country:US
Practice Address - Phone:405-239-6815
Practice Address - Fax:405-239-2637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION TREATMENT CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-20
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder