Provider Demographics
NPI:1447564315
Name:ADELANTE DEVELOPMENT CENTER, INC.
Entity Type:Organization
Organization Name:ADELANTE DEVELOPMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-341-2000
Mailing Address - Street 1:3900 OSUNA RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4459
Mailing Address - Country:US
Mailing Address - Phone:505-341-2000
Mailing Address - Fax:505-341-2001
Practice Address - Street 1:5411 OSUNA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2586
Practice Address - Country:US
Practice Address - Phone:505-883-0215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services