MEDICARE: ADAPT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor	OR
2	261Q00000X	Clinic/Center
3	324500000X	Substance Abuse Rehabilitation Facility
4	3245S0500X	Children's Substance Abuse Rehabilitation Facility	OR
5	101YA0400X	Addiction (Substance Use Disorder) Counselor	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720010549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAPT

Provider Business Mailing Address
First Line	:	PO BOX 1121
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-0254
Country	:	US
Telephone Number	:	541-672-2691
Fax Number	:	541-673-5642

Provider Business Practice Location Address
First Line	:	621 W MADRONE ST
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-3090
Country	:	US
Telephone Number	:	541-672-2691
Fax Number	:	541-673-5642

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRUCE PIPER
Credential	:
Telephone Number	:	541-672-2691

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/26/2018

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1063340438 — EMILY MCCAFFERY
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1174571244 — MS. LINDA LOU WESTFALL WHCNP, NMNP
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1154431542 — DR. DERIC V RAVSTEN D.O.
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621 W MADRONE ST STE 330
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Directions to “ADAPT ” Practice Location

Language	Start Address	Practice Location

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