Healthcare Provider Details

I. General information

NPI: 1538720396
Provider Name (Legal Business Name): ADAPTIVE INTERVENTIONS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 ROBINSON DR
CHERRYVILLE NC
28021-8100
US

IV. Provider business mailing address

1660 STANLEY LUCIA RD
MOUNT HOLLY NC
28120-9735
US

V. Phone/Fax

Practice location:
  • Phone: 704-789-3029
  • Fax: 800-292-0277
Mailing address:
  • Phone: 980-448-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVI CUNNINGHAM
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 980-448-4614