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General NPI Number Information
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NPI Number | 1134669468
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Entity Type | Organization
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Legal Business Name | AFRICAN AMERICAN YOUTH HARVEST FOUNDATION
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 6633 E HWY 290 SUITE 307
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City | AUSTIN
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State | TX
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Zip | 78723-1172
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Country | US
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Telephone | 512-428-4480
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Fax | 512-291-6103
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Provider Business Mailing Address
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Address Line | 6633 E HWY 290 SUITE 307
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City | AUSTIN
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State | TX
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Zip | 78723-1172
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Country | US
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Telephone | 512-428-4480
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Fax | 512-291-6103
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL LOFTON
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Credential | CEO
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Telephone | 512-585-6696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 64648
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License Number State | TX
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