Provider Demographics
NPI:1164287975
Name:BOSTON CERTIFIED AFC
Entity Type:Organization
Organization Name:BOSTON CERTIFIED AFC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZION
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-201-1412
Mailing Address - Street 1:199 REVERE ST RM 6
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4682
Mailing Address - Country:US
Mailing Address - Phone:857-201-1412
Mailing Address - Fax:
Practice Address - Street 1:199 REVERE ST RM 6
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4682
Practice Address - Country:US
Practice Address - Phone:857-201-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency