Provider Demographics
NPI:1295562155
Name:AGAVE HEALING ARTS LLC
Entity type:Organization
Organization Name:AGAVE HEALING ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIME
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-579-7606
Mailing Address - Street 1:256 PINON WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-6902
Mailing Address - Country:US
Mailing Address - Phone:703-579-7606
Mailing Address - Fax:
Practice Address - Street 1:6657 STATE ROUTE 179 STE C1
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7000
Practice Address - Country:US
Practice Address - Phone:703-579-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty