Healthcare Provider Details

I. General information

NPI: 1255087342
Provider Name (Legal Business Name): ANTHONY ADAMS HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2022
Last Update Date: 02/27/2022
Certification Date: 02/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E MICHIGAN BLVD STE B
MICHIGAN CITY IN
46360-5369
US

IV. Provider business mailing address

PO BOX 262
MICHIGAN CITY IN
46361-0262
US

V. Phone/Fax

Practice location:
  • Phone: 219-214-6505
  • Fax:
Mailing address:
  • Phone: 219-214-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: CANDICE NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 219-214-6505