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General NPI Number Information
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NPI Number | 1366745010
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Entity Type | Organization
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Legal Business Name | ADEC INC
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 3302 N. MAIN ST
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City | MICHAWAKA
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State | IN
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Zip | 46545-3148
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Country | US
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Telephone | 574-848-7451
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Fax | 574-848-5917
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Provider Business Mailing Address
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Address Line | P O BOX 398 19670 SR 120
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City | BRISTOL
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State | IN
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Zip | 46507-0398
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Country | US
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Telephone | 574-848-7451
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MS. PAULA M SHIVELY
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Credential |
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Telephone | 574-848-7451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 2670B0031JN04
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License Number State | IN
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