MEDICARE: ADAPT OF MISSOURI, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0850X	Adult Mental Health Clinic/Center
4	261QP2300X	Primary Care Clinic/Center
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1417004623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAPT OF MISSOURI, LLC

Provider Business Mailing Address
First Line	:	2301 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2908
Country	:	US
Telephone Number	:	888-657-3201
Fax Number	:	314-781-3295

Provider Business Practice Location Address
First Line	:	2301 HAMPTON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2908
Country	:	US
Telephone Number	:	888-657-3201
Fax Number	:	314-781-3295

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	TERESA PORTER
Credential	:
Telephone Number	:	636-466-6452

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	09/17/2024

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