Provider Demographics
NPI:1225167216
Name:AIDS LEADERSHIP FOOTHILLS-AREA ALLIANCE, INC.
Entity Type:Organization
Organization Name:AIDS LEADERSHIP FOOTHILLS-AREA ALLIANCE, INC.
Other - Org Name:ALFA
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GANTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-1447
Mailing Address - Street 1:1120 FAIRGROVE CHURCH RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9630
Mailing Address - Country:US
Mailing Address - Phone:828-322-1447
Mailing Address - Fax:828-322-8795
Practice Address - Street 1:1120 FAIRGROVE CHURCH RD
Practice Address - Street 2:SUITE 28
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9630
Practice Address - Country:US
Practice Address - Phone:828-322-1447
Practice Address - Fax:828-322-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70602251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8700210Medicaid