Healthcare Provider Details

I. General information

NPI: 1275355687
Provider Name (Legal Business Name): RAHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BOSTON TURNPIKE SUITE 308A
SHREWSBURY MA
01545
US

IV. Provider business mailing address

415 BOSTON TURNPIKE SUITE 308A
SHREWSBURY MA
01545
US

V. Phone/Fax

Practice location:
  • Phone: 774-329-7970
  • Fax:
Mailing address:
  • Phone: 774-329-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED MANSOUR
Title or Position: CEO
Credential:
Phone: 774-329-7970