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General NPI Number Information
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NPI Number | 1346532900
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Entity Type | Organization
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Legal Business Name | ADAPT OF ILLINOIS, INC.
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 517 CATAWBA AVE
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City | SWANSEA
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State | IL
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Zip | 62226-1659
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Country | US
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Telephone | 877-553-9440
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Fax | 312-553-9441
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Provider Business Mailing Address
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Address Line | 105 W MADISON ST STE 1600
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City | CHICAGO
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State | IL
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Zip | 60602-4652
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Country | US
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Telephone | 877-553-9440
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Fax | 312-553-9441
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CYNTHIA JANICAK
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Credential | MS
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Telephone | 877-553-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 04003
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License Number State | IL
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