Basic Information
| Provider Information | |||||||||
| NPI: | 1346522398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADAPT PROGRAMS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 474 | ||||||||
| Address2: | |||||||||
| City: | ANGLETON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775160474 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 BEAUMONT AVE | ||||||||
| Address2: | SUITE D-1 | ||||||||
| City: | LIBERTY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775755126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9794803327 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2011 | ||||||||
| LastUpdateDate: | 10/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | GARDZINA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9794803327 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 7657 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 1609199348 | 01 | TX | NPI | OTHER | 1184920472 | 01 | TX | NPI | OTHER | 217338 | 05 | TX | MEDICAID | 2174146 | 05 | TX | MEDICAID |