Provider Demographics
NPI:1144387648
Name:ADAMS GROUP HOME
Entity Type:Organization
Organization Name:ADAMS GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:BONNETTE
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-1551
Mailing Address - Street 1:PO BOX 7917
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71306-0917
Mailing Address - Country:US
Mailing Address - Phone:318-445-1551
Mailing Address - Fax:318-445-1242
Practice Address - Street 1:1214 PRESIDENTS DRIVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303
Practice Address - Country:US
Practice Address - Phone:318-443-7709
Practice Address - Fax:318-443-7710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE HABILITATION CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-03
Last Update Date:2009-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA945315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19G573Medicaid
LA1714593OtherUNISYS