Provider Demographics
NPI: | 1669987475 |
---|---|
Name: | PARKERSBURG TREATMENT CENTER, LLC |
Entity type: | Organization |
Organization Name: | PARKERSBURG TREATMENT CENTER, LLC |
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: | 184 HOLIDAY HILLS DR |
Practice Address - Street 2: | |
Practice Address - City: | PARKERSBURG |
Practice Address - State: | WV |
Practice Address - Zip Code: | 26104-8006 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-420-2400 |
Practice Address - Fax: | 304-420-9014 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ACADIA HEALTHCARE COMPANY, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-12-04 |
Last Update Date: | 2023-08-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone |