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NPI Code Detail

MEDICARE: ADAPT OF ILLINOIS, INC.

MEDICARE: ADAPT OF ILLINOIS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1629360284
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADAPT OF ILLINOIS, INC.
Provider Business Mailing Address
First Line : 2600 WEST BLVD
Second Line :
City : BELLEVILLE
State : IL
Zip : 62221-5605
Country : US
Telephone Number : 877-553-9440
Fax Number : 312-553-9441
Provider Business Practice Location Address
First Line : 321 ARNOLD AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2315
Country : US
Telephone Number : 877-553-9440
Fax Number : 312-553-9441
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : CYNTHIA JANICAK
Credential : MS
Telephone Number : 877-553-9440
Provider Enumeration Date : 05/13/2011
Last Update Date : 09/28/2022

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