Provider Demographics
NPI:1447964168
Name:ADICOM
Entity type:Organization
Organization Name:ADICOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NON LICENSE BEHAVIOR HEALTH PROVIDE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-505-7467
Mailing Address - Street 1:604 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2231
Mailing Address - Country:US
Mailing Address - Phone:504-505-7467
Mailing Address - Fax:
Practice Address - Street 1:604 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-2231
Practice Address - Country:US
Practice Address - Phone:504-505-7467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty