Provider Demographics
NPI:1831601764
Name:AEGIS TREATMENT CENTERS, LLC
Entity type:Organization
Organization Name:AEGIS TREATMENT CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IN-HOUSE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:THAIPHONG
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-206-0360
Mailing Address - Street 1:7246 REMMET AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1531
Mailing Address - Country:US
Mailing Address - Phone:818-206-0360
Mailing Address - Fax:818-206-0383
Practice Address - Street 1:7246 REMMET AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1531
Practice Address - Country:US
Practice Address - Phone:818-206-0360
Practice Address - Fax:818-206-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15-06261QM2800X
CA19-156261QM2800X
CA10-07261QM2800X
CA36-12261QM2800X
CA39-13261QM2800X
CA39-14261QM2800X
CA19-158261QM2800X
CA51-05261QM2800X
CA24-02261QM2800X
CA40-02261QM2800X
CA15-05261QM2800X
CA15-07261QM2800X
CA04-02261QM2800X
CA04-02MU1261QM2800X
CA19-154261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone