Provider Demographics
NPI:1669728051
Name:ACIDOM CONSULTING GROUP
Entity type:Organization
Organization Name:ACIDOM CONSULTING GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MODICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-340-8880
Mailing Address - Street 1:931 WESTWOOD DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2400
Mailing Address - Country:US
Mailing Address - Phone:504-340-8880
Mailing Address - Fax:504-340-8884
Practice Address - Street 1:931 WESTWOOD DR
Practice Address - Street 2:SUITE E
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2400
Practice Address - Country:US
Practice Address - Phone:504-340-8880
Practice Address - Fax:504-340-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2023-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health