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General NPI Number Information
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NPI Number | 1932789757
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Entity Type | Organization
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Legal Business Name | SHARED HARVEST FOUNDATION INC
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 10000 WASHINGTON BLVD STE 600
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City | CULVER CITY
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State | CA
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Zip | 90232-2783
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Country | US
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Telephone | 323-880-0121
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Fax | 801-665-5652
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Provider Business Mailing Address
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Address Line | 23934 DECORAH RD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1407
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Country | US
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Telephone | 917-748-3832
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. NANAEFUA AFOH-MANIN
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Credential | MD
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Telephone | 917-748-3832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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