Provider Demographics
NPI:1437504909
Name:5 PEPPERS INC
Entity Type:Organization
Organization Name:5 PEPPERS INC
Other - Org Name:ACACIA WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEO
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEPPERSACK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:208-498-1760
Mailing Address - Street 1:217 W. GEORGIA AVE. STE 120
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686
Mailing Address - Country:US
Mailing Address - Phone:208-498-1760
Mailing Address - Fax:
Practice Address - Street 1:217 W. GEORGIA AVE. STE 120
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686
Practice Address - Country:US
Practice Address - Phone:208-498-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty