1013375757 NPI number — ADAPTIVE THERAPY, INC.

Table of content: (NPI 1013375757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013375757 NPI number — ADAPTIVE THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAPTIVE THERAPY, 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:
1013375757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6015 NEW FOREST CT
Provider Second Line Business Mailing Address:
APT 5
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20603-4735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-607-9207
Provider Business Mailing Address Fax Number:
301-934-2640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 LA GRANGE AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LA PLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646-9592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-253-7051
Provider Business Practice Location Address Fax Number:
301-934-2640
Provider Enumeration Date:
02/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ETTS
Authorized Official First Name:
OLIMPIA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
917-576-7237

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  15217 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com