Provider Demographics
NPI:1023862075
Name:SOCIETY FOR EQUAL ACCESS, INDEPENDENT LIVING CENTER
Entity type:Organization
Organization Name:SOCIETY FOR EQUAL ACCESS, INDEPENDENT LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-343-9292
Mailing Address - Street 1:22 BANK LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1903
Mailing Address - Country:US
Mailing Address - Phone:330-343-9292
Mailing Address - Fax:
Practice Address - Street 1:22 BANK LN
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1903
Practice Address - Country:US
Practice Address - Phone:330-343-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)