Organization
SANTA ROSA TREATMENT PROGRAM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEE ROY TILLMAN (PROGRAM DIRECTOR/CEO)
(707) 576-0818
Entity
Organization
Contact information
Practice address
625 STEELE LANE, SANTA ROSA, CA 95403-3127
(707) 576-0818
(707) 576-7845
Mailing address
625 STEELE LANE, SANTA ROSA, CA 95403-3127
(707) 576-0818
(707) 576-7845
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
49-02
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3631909
EDD STATE PROVIDER
CA
01
—
49-02
DHCS NTP
CA
05
—
49AC
—
CA
01
—
CA-10228-M
CSAT (SAMHSA)
—
Enumeration date
07/07/2005
Last updated
03/07/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up