1811048390 NPI number — DISABILITY SERVICES INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811048390 NPI number — DISABILITY SERVICES INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISABILITY SERVICES INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCKINLEY OPPORTUNITY & RESOURCE ENTERPRISES
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811048390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLUP
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87305-1296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-722-4383
Provider Business Mailing Address Fax Number:
505-722-2191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 WILLIAMS ST
Provider Second Line Business Practice Location Address:
BLDG. #16
Provider Business Practice Location Address City Name:
GALLUP
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87301-4799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-722-4383
Provider Business Practice Location Address Fax Number:
505-722-2191
Provider Enumeration Date:
01/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LACAYO
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
I
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
505-722-4383

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E7471 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: D0664 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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