MEDICARE: ADELANTE DEVELOPMENT CENTER, 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1447564315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADELANTE DEVELOPMENT CENTER, INC.

Provider Business Mailing Address
First Line	:	3900 OSUNA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4459
Country	:	US
Telephone Number	:	505-341-2000
Fax Number	:	505-341-2001

Provider Business Practice Location Address
First Line	:	5411 OSUNA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-2586
Country	:	US
Telephone Number	:	505-883-0215
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. MIKE KIVITZ
Credential	:
Telephone Number	:	505-341-2000

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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