Healthcare Provider Details

I. General information

NPI: 1346962800
Provider Name (Legal Business Name): FAMILY TREE AFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 LINDEN ST # 200
WELLESLEY MA
02482-5900
US

IV. Provider business mailing address

277 LINDEN ST # 200
WELLESLEY MA
02482-5900
US

V. Phone/Fax

Practice location:
  • Phone: 617-293-4594
  • Fax:
Mailing address:
  • Phone: 617-293-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC VORONOV
Title or Position: PRESIDENT
Credential:
Phone: 617-293-4594