Healthcare Provider Details

I. General information

NPI: 1437358330
Provider Name (Legal Business Name): ADULT SYSTEMS OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5362 LEMEE LANE
MARIPOSA CA
95338
US

IV. Provider business mailing address

PO BOX 99
MARIPOSA CA
95338-0099
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-2000
  • Fax: 209-966-8251
Mailing address:
  • Phone: 209-966-2000
  • Fax: 209-966-8251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOHN LAWLESS
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 209-966-2000