Healthcare Provider Details

I. General information

NPI: 1821163130
Provider Name (Legal Business Name): DAC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 E MAPLE ST
MAQUOKETA IA
52060-9214
US

IV. Provider business mailing address

1710 E MAPLE ST
MAQUOKETA IA
52060-9214
US

V. Phone/Fax

Practice location:
  • Phone: 563-652-5252
  • Fax: 563-652-4872
Mailing address:
  • Phone: 563-652-5252
  • Fax: 563-652-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberIME625
License Number StateIA

VIII. Authorized Official

Name: MR. TODD SEIFERT
Title or Position: CEO
Credential:
Phone: 563-652-5252