Provider Demographics
NPI:1730362534
Name:ADAPT
Entity type:Organization
Organization Name:ADAPT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-672-2691
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0254
Mailing Address - Country:US
Mailing Address - Phone:541-672-2691
Mailing Address - Fax:541-673-5642
Practice Address - Street 1:2064 SE DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3713
Practice Address - Country:US
Practice Address - Phone:541-673-5119
Practice Address - Fax:541-957-3734
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADAPT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-14
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218156Medicaid
OR218156Medicaid