Provider Demographics
NPI:1861939365
Name:ADI-OP, INC.
Entity type:Organization
Organization Name:ADI-OP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:BLAIRE
Authorized Official - Last Name:SHAWHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-879-7581
Mailing Address - Street 1:1900 CAMDEN AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2942
Mailing Address - Country:US
Mailing Address - Phone:408-879-7581
Mailing Address - Fax:
Practice Address - Street 1:1900 CAMDEN AVE
Practice Address - Street 2:STE 205
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2942
Practice Address - Country:US
Practice Address - Phone:408-879-7581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430068AP261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder