Provider Demographics
NPI:1043695794
Name:ETHIOPIAN DREAM CENTER INC.
Entity Type:Organization
Organization Name:ETHIOPIAN DREAM CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MESFIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BESHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-762-8085
Mailing Address - Street 1:18A MILLBURY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2812
Mailing Address - Country:US
Mailing Address - Phone:857-333-4525
Mailing Address - Fax:
Practice Address - Street 1:18A MILLBURY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2812
Practice Address - Country:US
Practice Address - Phone:857-333-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health