Healthcare Provider Details

I. General information

NPI: 1912674698
Provider Name (Legal Business Name): ADAPTIVE HOME SLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COUNTY HIGHWAY 473
SIKESTON MO
63801-8489
US

IV. Provider business mailing address

740 COUNTY HIGHWAY 473
SIKESTON MO
63801-8489
US

V. Phone/Fax

Practice location:
  • Phone: 573-270-4252
  • Fax:
Mailing address:
  • Phone: 573-270-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN MARC DECKER
Title or Position: OWNER
Credential:
Phone: 573-270-4252