SANTA ROSA TREATMENT PROGRAM INC. NPI 1285631978

NPI Information

  • NPI: 1285631978
  • Provider Name: SANTA ROSA TREATMENT PROGRAM, INC.
  • Classification: Clinic/Center - 261QM2800X
  • Specialization: Methadone
  • Entity Type: Organization
  • CLIA Number: 05D0904143
  • Address: 625 STEELE LANE
    SANTA ROSA, CA
    ZIP 95403
  • Phone: (707) 576-0818

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NPI Details

SANTA ROSA TREATMENT PROGRAM, INC. is a methadone clinic center in Santa Rosa, CA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. SANTA ROSA TREATMENT PROGRAM, INC. NPI is 1285631978. The provider is registered as an organization entity type.

The provider's business location address is:

625 STEELE LANE
SANTA ROSA, CA
ZIP 95403-127
Phone: (707) 576-0818
Fax: (707) 576-7845

The provider's authorized official is Lee Roy Tillman .
The authorized official title is Program Director/ceo and has the following contact phone number (707) 576-0818.

The CLIA number assigned to this NPI record is 05D0904143 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm (HCPCS:G2067)

The enumeration date for this NPI number is 7/7/2005 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2800XClinic/CenterMethadone49-02CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13631909OTHERCALIFORNIAEDD STATE PROVIDER
2CA-10228-MOTHERCSAT (SAMHSA)
349-02OTHERCALIFORNIADHCS NTP
449ACMEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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