Provider Demographics
NPI:1184090409
Name:AL&G ENTERPRIZE
Entity type:Organization
Organization Name:AL&G ENTERPRIZE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HAIR LOSS SPECIALLST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-390-1501
Mailing Address - Street 1:2243 MOUNT HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-6226
Mailing Address - Country:US
Mailing Address - Phone:870-390-1501
Mailing Address - Fax:
Practice Address - Street 1:2243 MOUNT HOLLY RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-6226
Practice Address - Country:US
Practice Address - Phone:870-390-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA BEAUTY HAIR SALON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1744P3200X1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1744P3200XOtherCERTIFIED HAIR LOSS SPECIALIST