TRI-STATE TREATMENT,LLC
NPI 1780036210
Substance Abuse Rehabilitation Facility in Wildwood, GA

Q: What is Tri-State Treatment,llc's NPI number?

The NPI number for Tri-State Treatment,llc is 1780036210. It was assigned to this organization in the NPPES registry on July 8, 2016.

Q: What is Tri-State Treatment,llc's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Active since July 08, 2016CLIA 11D2136124 · Waiver

1236 HIGHWAY 299, WILDWOOD, GA 30757(423) 428-0045(423) 428-0046 Get Directions Write a Review

NPPES record last updated: March 20, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Tri-state Treatment,llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRI-STATE TREATMENT,LLC (NPI 1780036210) is a healthcare organization registered as a substance abuse rehabilitation facility in Wildwood, Georgia and active in the NPI registry since July 2016. The organization holds a CLIA Waiver certificate valid through September 4, 2027 and lists Melissa M Hancock, Administrator, as its authorized official.

NPPES Registry Identity

NPI1780036210

Entity TypeOrganization

Primary Taxonomy324500000X

Legal Business NameTRI-STATE TREATMENT,LLC

Location Address1236 HIGHWAY 299Wildwood, GA 30757-4003

Mailing Address1236 Highway 299Wildwood, GA 30757-4003 · (423) 428-0045 · Fax (423) 428-0046

Phone(423) 428-0045

Fax(423) 428-0046

Organization SubpartNo

Authorized OfficialMelissa M HancockAdministrator · (423) 428-0045

Enumeration DateJuly 8, 2016

Last NPPES UpdateMarch 20, 2024

NPPES CertifiedMarch 20, 2024

✔ NPI 1780036210 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities

Taxonomy Code324500000X

License✔ Licensed in GA · NTP001071

Definition

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

1236 HIGHWAY 299, Wildwood, GA 30757

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2136124

Tri-State Treatment · Wildwood, GA

Active · expires Sep 4, 2027

CLIA Number11D2136124

Laboratory TypeOplate Treatment Program

Certificate Effective DateSeptember 5, 2025

Certificate Expiration DateSeptember 4, 2027

Laboratory DirectorMelissa M. Hancock

Laboratory Phone(423) 428-0045

Laboratory LocationTri-State Treatment1236 Highway 299, Wildwood, GA 30757

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure G2078

This service provides an additional 7-day supply of methadone, a medication used to treat opioid addiction, for patients to take at home. It's provided by a Medicare-enrolled opioid treatment program. This service is billed separately from the main treatment procedure.

1,018 services36 patients

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 G2067

Medication Assisted Treatment (MAT) with methadone is a comprehensive approach to manage opioid addiction. It includes weekly methadone dispensing, substance use counseling, individual and group therapy sessions, and toxicology tests as needed, all provided by a Medicare-enrolled opioid treatment program.

560 services39 patients

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Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ABIGAIL WHITE CSC, CADC-II

Counselor (Addiction (Substance Use Disorder))