Provider Demographics
NPI:1396861480
Name:DISABILITY ACTION CENTER
Entity Type:Organization
Organization Name:DISABILITY ACTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-883-0523
Mailing Address - Street 1:307 19TH ST STE A1
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2086
Mailing Address - Country:US
Mailing Address - Phone:208-746-9033
Mailing Address - Fax:208-746-1004
Practice Address - Street 1:124 E 3RD ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2906
Practice Address - Country:US
Practice Address - Phone:208-883-0523
Practice Address - Fax:208-883-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health