Healthcare Provider Details

I. General information

NPI: 1326318114
Provider Name (Legal Business Name): ADAPTIVE COMPANION CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6838 W THORNEBUSH DR
MC CORDSVILLE IN
46055-4425
US

IV. Provider business mailing address

33 S STATE ST FL 5
CHICAGO IL
60603-2804
US

V. Phone/Fax

Practice location:
  • Phone: 502-802-8287
  • Fax:
Mailing address:
  • Phone: 312-762-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number11-012735-1
License Number StateIN

VIII. Authorized Official

Name: JOSEPH BONACCORSI
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 312-762-9999