Provider Demographics
NPI:1770635633
Name:AIDS ACTION COALITION OF HUNTSVILLE
Entity Type:Organization
Organization Name:AIDS ACTION COALITION OF HUNTSVILLE
Other - Org Name:THRIVE ALABAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-445-5438
Mailing Address - Street 1:600 ST CLAIR AVE SW
Mailing Address - Street 2:BLDG 3
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5057
Mailing Address - Country:US
Mailing Address - Phone:256-536-4700
Mailing Address - Fax:256-536-4117
Practice Address - Street 1:600 ST CLAIR AVE SW
Practice Address - Street 2:BLDG 3
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5057
Practice Address - Country:US
Practice Address - Phone:256-536-4700
Practice Address - Fax:256-382-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty