Provider Demographics
NPI:1275073926
Name:ADAPTIVE LIVING, LLC
Entity type:Organization
Organization Name:ADAPTIVE LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LIANE TALLEY
Authorized Official - Last Name:HOPPS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CAPS
Authorized Official - Phone:360-209-4199
Mailing Address - Street 1:805 CARLYON AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3501
Mailing Address - Country:US
Mailing Address - Phone:360-209-4199
Mailing Address - Fax:360-346-1024
Practice Address - Street 1:805 CARLYON AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-3501
Practice Address - Country:US
Practice Address - Phone:360-209-4199
Practice Address - Fax:360-346-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00003587251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health