Basic Information
| Provider Information | |||||||||
| NPI: | 1770998932 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AEGIS TREATMENT CENTERS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AEGIS TREATMENT CENTERS LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4129 STATE ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059644795 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4129 STATE ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059644795 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2014 | ||||||||
| LastUpdateDate: | 06/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | GUERREREO | ||||||||
| AuthorizedOfficialFirstName: | YOVANA | ||||||||
| AuthorizedOfficialMiddleName: | LIZETH | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 8059644795 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.