1770970576 NPI number — ADAPTIVE COMMUNITY SUPPORT SERVICES INC

Table of content: (NPI 1770970576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770970576 NPI number — ADAPTIVE COMMUNITY SUPPORT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAPTIVE COMMUNITY SUPPORT SERVICES 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:
6
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:
1770970576
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3006 EASTPOINT PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-4185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-795-0773
Provider Business Mailing Address Fax Number:
800-990-2526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3216 BALLARD LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-590-2157
Provider Business Practice Location Address Fax Number:
800-990-2526
Provider Enumeration Date:
04/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PELKINGTON
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGEMENT DIRECTOR
Authorized Official Telephone Number:
317-746-5391

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300007217 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300042650 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300076118 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300097057 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300075572 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100721010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300042413 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300063174 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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