MEDICARE: ADAPT OF ILLINOIS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164714721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAPT OF ILLINOIS, INC.

Provider Business Mailing Address
First Line	:	2600 WEST BLVD
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5605
Country	:	US
Telephone Number	:	877-553-9440
Fax Number	:	312-553-9441

Provider Business Practice Location Address
First Line	:	2600 WEST BLVD
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-5605
Country	:	US
Telephone Number	:	877-553-9440
Fax Number	:	312-553-9441

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CYNTHIA JANICAK
Credential	:	MS
Telephone Number	:	877-553-9440

Provider Enumeration Date	:	05/13/2011
Last Update Date	:	07/28/2025

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