Provider Demographics
NPI:1275930992
Name:MAMATOTO VILLAGE INC
Entity Type:Organization
Organization Name:MAMATOTO VILLAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AZA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-248-3434
Mailing Address - Street 1:311 47TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4642
Mailing Address - Country:US
Mailing Address - Phone:202-248-3434
Mailing Address - Fax:
Practice Address - Street 1:311 47TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4642
Practice Address - Country:US
Practice Address - Phone:202-248-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty