Provider Demographics
NPI:1619588621
Name:ADAPTIVE FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:ADAPTIVE FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONTRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-820-1862
Mailing Address - Street 1:4898 GA HIGHWAY 315 APT 401
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-4989
Mailing Address - Country:US
Mailing Address - Phone:678-820-1862
Mailing Address - Fax:
Practice Address - Street 1:311 SEALE RD
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-6917
Practice Address - Country:US
Practice Address - Phone:678-820-1862
Practice Address - Fax:866-580-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1619320306OtherNPI
GA1083033005OtherNPI