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General NPI Number Information
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NPI Number | 1255673729
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Entity Type | Organization
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Legal Business Name | AFRICAN HERITAGE INTERNATIONAL INC
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 738 MAIN ST # 425
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City | WALTHAM
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State | MA
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Zip | 02451-0616
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Country | US
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Telephone | 781-535-4929
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Fax |
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Provider Business Mailing Address
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Address Line | 738 MAIN ST # 425
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City | WALTHAM
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State | MA
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Zip | 02451-0616
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Country | US
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Telephone | 781-535-4929
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Fax |
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | MR. OTHUMAN W NTALE
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Credential | HONS EDUC
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Telephone | 781-535-4929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State | MA
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