Provider Demographics
NPI:1578894184
Name:ADAMS PLACE FOR WELLNESS LLC
Entity Type:Organization
Organization Name:ADAMS PLACE FOR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:937-439-2955
Mailing Address - Street 1:848D E. FRANKLIN STR
Mailing Address - Street 2:#4
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-439-2955
Mailing Address - Fax:937-439-2970
Practice Address - Street 1:848 E FRANKLIN ST STE D4
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-5693
Practice Address - Country:US
Practice Address - Phone:937-439-2955
Practice Address - Fax:937-439-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-8178251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11695319OtherCAQH
OH2443092Medicaid
OHADSW31571Medicare PIN