1780562884 NPI number — ADAPT OF ILLINOIS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780562884 NPI number — ADAPT OF ILLINOIS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAPT OF ILLINOIS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780562884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 WEST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62221-5605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-553-9440
Provider Business Mailing Address Fax Number:
618-235-2493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3490 HUMBERT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62002-7101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-553-9440
Provider Business Practice Location Address Fax Number:
618-235-2493
Provider Enumeration Date:
08/26/2025

Additional Information

Authorized Official

Authorized Official Last Name:
JANICAK
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
877-553-9440

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04003 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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