Provider Demographics
NPI:1205454105
Name:LD-HUNTSVILLE, LLC
Entity type:Organization
Organization Name:LD-HUNTSVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAIGNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA
Authorized Official - Phone:256-783-9468
Mailing Address - Street 1:4240 BALMORAL DR SW STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5633
Mailing Address - Country:US
Mailing Address - Phone:256-852-9878
Mailing Address - Fax:866-256-7588
Practice Address - Street 1:4240 BALMORAL DR SW STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5633
Practice Address - Country:US
Practice Address - Phone:256-852-9878
Practice Address - Fax:662-586-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental