Provider Demographics
NPI:1902268980
Name:ACIDOM MEDICAL SERVICES II LLC
Entity Type:Organization
Organization Name:ACIDOM MEDICAL SERVICES II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:504-296-3365
Mailing Address - Street 1:3864 DEERCREEK LN
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2115
Mailing Address - Country:US
Mailing Address - Phone:504-296-3365
Mailing Address - Fax:504-340-8884
Practice Address - Street 1:3864 DEERCREEK LN
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-2115
Practice Address - Country:US
Practice Address - Phone:504-296-3365
Practice Address - Fax:504-340-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health