Provider Demographics
NPI:1558660670
Name:5 PEPPER INC DBA ACACIA WELLNESS CENTER
Entity Type:Organization
Organization Name:5 PEPPER INC DBA ACACIA WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPERSACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-498-1760
Mailing Address - Street 1:353 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2856
Mailing Address - Country:US
Mailing Address - Phone:208-498-1760
Mailing Address - Fax:
Practice Address - Street 1:353 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2856
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:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health