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General NPI Number Information
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NPI Number | 1861939365
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Entity Type | Organization
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Legal Business Name | ADI-OP, INC.
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 1900 CAMDEN AVE STE 205
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City | SAN JOSE
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State | CA
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Zip | 95124-2942
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Country | US
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Telephone | 408-879-7581
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 CAMDEN AVE STE 205
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City | SAN JOSE
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State | CA
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Zip | 95124-2942
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Country | US
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Telephone | 408-879-7581
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS MELISSA BLAIRE SHAWHAN
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Credential |
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Telephone | 408-879-7581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 430068AP
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License Number State | CA
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