Healthcare Provider Details

I. General information

NPI: 1144401043
Provider Name (Legal Business Name): ADAPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 NW 6TH ST SUITE 102
GRANTS PASS OR
97526-2006
US

IV. Provider business mailing address

PO BOX 1121
ROSEBURG OR
97470-0254
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-1033
  • Fax: 541-474-0770
Mailing address:
  • Phone: 541-672-2691
  • Fax: 541-673-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRUCE PIPER
Title or Position: CEO
Credential:
Phone: 541-672-2691