Healthcare Provider Details

I. General information

NPI: 1275930992
Provider Name (Legal Business Name): MAMATOTO VILLAGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 SHERIFF RD NE
WASHINGTON DC
20019-3739
US

IV. Provider business mailing address

4315 SHERIFF RD NE
WASHINGTON DC
20019-3739
US

V. Phone/Fax

Practice location:
  • Phone: 202-248-3434
  • Fax:
Mailing address:
  • Phone: 202-248-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MS. AZA NEDHARI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-248-3434