Provider Demographics
NPI:1245378371
Name:ADAMS STREET PLACE, INC.
Entity Type:Organization
Organization Name:ADAMS STREET PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:573-635-1320
Mailing Address - Street 1:1024 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-3408
Mailing Address - Country:US
Mailing Address - Phone:573-635-1320
Mailing Address - Fax:573-634-3944
Practice Address - Street 1:1024 ADAMS ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3408
Practice Address - Country:US
Practice Address - Phone:573-635-1320
Practice Address - Fax:573-634-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033716314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265810Medicare Oscar/Certification