Provider Demographics
NPI:1073936217
Name:ADAPT ST JOE INC
Entity Type:Organization
Organization Name:ADAPT ST JOE INC
Other - Org Name:WESTBROOK
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KNISELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-279-7531
Mailing Address - Street 1:202 MORSE ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1477
Mailing Address - Country:US
Mailing Address - Phone:517-279-7531
Mailing Address - Fax:517-278-3154
Practice Address - Street 1:202 MORSE ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1477
Practice Address - Country:US
Practice Address - Phone:517-279-7531
Practice Address - Fax:517-278-3154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI120091717320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities