MEDICARE: ADDOM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1629474218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDOM, INC.

Provider Business Mailing Address
First Line	:	3260 BLUME DR
Second Line	:	SUITE 425
City	:	RICHMOND
State	:	CA
Zip	:	94806-5203
Country	:	US
Telephone Number	:	510-243-9987
Fax Number	:	510-243-9991

Provider Business Practice Location Address
First Line	:	3260 BLUME DR
Second Line	:	SUITE 425
City	:	RICHMOND
State	:	CA
Zip	:	94806-5203
Country	:	US
Telephone Number	:	510-243-9987
Fax Number	:	510-243-9991

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MR. DOMIQUE PACLIBAR
Credential	:	RN
Telephone Number	:	510-243-9987

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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Directions to “ADDOM, INC. ” Practice Location

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