Provider Demographics
NPI:1629474218
Name:ADDOM, INC.
Entity Type:Organization
Organization Name:ADDOM, INC.
Other - Org Name:AMAZING GRACE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PACLIBAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-243-9987
Mailing Address - Street 1:3260 BLUME DR
Mailing Address - Street 2:SUITE 425
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5203
Mailing Address - Country:US
Mailing Address - Phone:510-243-9987
Mailing Address - Fax:510-243-9991
Practice Address - Street 1:3260 BLUME DR
Practice Address - Street 2:SUITE 425
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5203
Practice Address - Country:US
Practice Address - Phone:510-243-9987
Practice Address - Fax:510-243-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health