Provider Demographics
NPI:1497985998
Name:ADAPT FOUNDATION INC
Entity Type:Organization
Organization Name:ADAPT FOUNDATION INC
Other - Org Name:BRAZOS PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDZINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:832-892-2055
Mailing Address - Street 1:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77516-0474
Mailing Address - Country:US
Mailing Address - Phone:979-233-3826
Mailing Address - Fax:281-377-5870
Practice Address - Street 1:1103 N AVENUE H
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-4006
Practice Address - Country:US
Practice Address - Phone:979-233-3826
Practice Address - Fax:979-233-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3994-3995324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065443601Medicaid