Healthcare Provider Details

I. General information

NPI: 1669677282
Provider Name (Legal Business Name): ASSEMBLIES OF GOD FAMILY SERVICES AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 MALVERN AVE
HOT SPRINGS AR
71901-8037
US

IV. Provider business mailing address

2325 MALVERN AVE
HOT SPRINGS AR
71901-8037
US

V. Phone/Fax

Practice location:
  • Phone: 501-262-1660
  • Fax: 501-262-0115
Mailing address:
  • Phone: 501-262-1660
  • Fax: 501-262-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAY MOONEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-262-1660