Provider Demographics
NPI:1356633911
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 1:2600 WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-5605
Mailing Address - Country:US
Mailing Address - Phone:877-553-9440
Mailing Address - Fax:312-553-9441
Practice Address - Street 1:310 BANBURY RD
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1260
Practice Address - Country:US
Practice Address - Phone:877-553-9440
Practice Address - Fax:312-543-1195
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAPT OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-13
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========009Medicaid