Basic Information
| Provider Information | |||||||||
| NPI: | 1700383080 | ||||||||
| 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: | 717 W SEALY ST | ||||||||
| Address2: | |||||||||
| City: | ALVIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775112162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558623278 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | GARDZINA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | MATTHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9794803327 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 3351-3352 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 3351-3352 | 01 | TX | STATE LICENSE | OTHER |