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
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