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General NPI Number Information
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NPI Number | 1255087342
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Entity Type | Organization
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Legal Business Name | ANTHONY ADAMS HOUSE
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Dates
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Enumeration Date | 02/27/2022
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Last Update Date | 02/27/2022
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Provider Practice Location Address
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Address Line | 2601 E MICHIGAN BLVD STE B
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-5369
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Country | US
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Telephone | 219-214-6505
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | MICHIGAN CITY
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State | IN
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Zip | 46361-0262
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Country | US
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Telephone | 219-214-6505
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CANDICE NELSON
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Credential |
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Telephone | 219-214-6505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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