Provider Demographics
NPI:1811048390
Name:DISABILITY SERVICES INCORPORATED
Entity type:Organization
Organization Name:DISABILITY SERVICES INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:LACAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-722-4383
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-1296
Mailing Address - Country:US
Mailing Address - Phone:505-722-4383
Mailing Address - Fax:505-722-2191
Practice Address - Street 1:503 WILLIAMS ST
Practice Address - Street 2:BLDG. #16
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-4799
Practice Address - Country:US
Practice Address - Phone:505-722-4383
Practice Address - Fax:505-722-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME7471Medicaid
NMD0664Medicaid