Provider Demographics
NPI:1346532900
Name:ADAPT OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:ADAPT OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANICAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:877-553-9440
Mailing Address - Street 1:105 W MADISON ST STE 1600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4652
Mailing Address - Country:US
Mailing Address - Phone:877-553-9440
Mailing Address - Fax:312-553-9441
Practice Address - Street 1:517 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1659
Practice Address - Country:US
Practice Address - Phone:877-553-9440
Practice Address - Fax:312-553-9441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAPT OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04003320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========013Medicaid