Healthcare Provider Details

I. General information

NPI: 1144387648
Provider Name (Legal Business Name): ADAMS GROUP HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 11/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 PRESIDENTS DRIVE
ALEXANDRIA LA
71303
US

IV. Provider business mailing address

PO BOX 7917
ALEXANDRIA LA
71306-0917
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-7709
  • Fax: 318-443-7710
Mailing address:
  • Phone: 318-445-1551
  • Fax: 318-445-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number945
License Number StateLA

VIII. Authorized Official

Name: MS. CHRISTINA BONNETTE BOLTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-445-1551