Provider Demographics
NPI:1255673729
Name:AFRICAN HERITAGE INTERNATIONAL INC
Entity Type:Organization
Organization Name:AFRICAN HERITAGE INTERNATIONAL INC
Other - Org Name:HERITAGE PRIDE HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OTHUMAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:NTALE
Authorized Official - Suffix:
Authorized Official - Credentials:HONS EDUC
Authorized Official - Phone:781-535-4929
Mailing Address - Street 1:738 MAIN ST # 425
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0616
Mailing Address - Country:US
Mailing Address - Phone:781-535-4929
Mailing Address - Fax:
Practice Address - Street 1:738 MAIN ST # 425
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0616
Practice Address - Country:US
Practice Address - Phone:781-535-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFRICAN HERITAGE INTERNATIONAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child