Provider Demographics
NPI:1770967465
Name:AEGIS TREATMENT CENTER, LLC.
Entity type:Organization
Organization Name:AEGIS TREATMENT CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:SEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-478-2487
Mailing Address - Street 1:8626 LOWER SACRAMENTO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95120
Mailing Address - Country:US
Mailing Address - Phone:209-478-2487
Mailing Address - Fax:
Practice Address - Street 1:8626 LOWER SACRAMENTO RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-1835
Practice Address - Country:US
Practice Address - Phone:209-487-2487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health