Provider Demographics
NPI:1417311150
Name:ADAPTIVE CARE SERVICES
Entity Type:Organization
Organization Name:ADAPTIVE CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAWANZA
Authorized Official - Middle Name:JAJA
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-346-6681
Mailing Address - Street 1:3524 WALLACE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-1921
Mailing Address - Country:US
Mailing Address - Phone:215-346-6681
Mailing Address - Fax:
Practice Address - Street 1:3524 WALLACE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1921
Practice Address - Country:US
Practice Address - Phone:215-346-6681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility