Provider Demographics
NPI:1669677282
Name:ASSEMBLIES OF GOD FAMILY SERVICES AGENCY
Entity Type:Organization
Organization Name:ASSEMBLIES OF GOD FAMILY SERVICES AGENCY
Other - Org Name:COMPACT FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-262-1660
Mailing Address - Street 1:2325 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8037
Mailing Address - Country:US
Mailing Address - Phone:501-262-1660
Mailing Address - Fax:501-262-0115
Practice Address - Street 1:2325 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8037
Practice Address - Country:US
Practice Address - Phone:501-262-1660
Practice Address - Fax:501-262-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child