Healthcare Provider Details

I. General information

NPI: 1770873002
Provider Name (Legal Business Name): ADAPT OF MISSOURI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HAMPTON AVE
SAINT LOUIS MO
63139-2908
US

IV. Provider business mailing address

2301 HAMPTON AVE
SAINT LOUIS MO
63139-2908
US

V. Phone/Fax

Practice location:
  • Phone: 888-657-3201
  • Fax: 314-781-3295
Mailing address:
  • Phone: 888-657-3201
  • Fax: 314-781-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TERESA PORTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 636-466-6452