Provider Demographics
NPI:1285246199
Name:SSA ACU ENDEAVORS LLC
Entity type:Organization
Organization Name:SSA ACU ENDEAVORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRANCHISE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:623-266-8688
Mailing Address - Street 1:823 E IRVINE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-8447
Mailing Address - Country:US
Mailing Address - Phone:623-266-8688
Mailing Address - Fax:
Practice Address - Street 1:20022 N 67TH AVE STE A116
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4619
Practice Address - Country:US
Practice Address - Phone:623-335-0875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty