Provider Demographics
NPI:1548273170
Name:AGAPE OF NORTH ALABAMA, INC.
Entity type:Organization
Organization Name:AGAPE OF NORTH ALABAMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:256-859-4481
Mailing Address - Street 1:PO BOX 3887
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-0887
Mailing Address - Country:US
Mailing Address - Phone:256-859-4481
Mailing Address - Fax:256-859-4483
Practice Address - Street 1:2813 MASTIN LAKE RD NW
Practice Address - Street 2:SUITE #200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-2815
Practice Address - Country:US
Practice Address - Phone:256-859-4481
Practice Address - Fax:256-859-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000262251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable