Provider Demographics
NPI:1346962800
Name:FAMILY TREE AFC
Entity Type:Organization
Organization Name:FAMILY TREE AFC
Other - Org Name:FAMILY TREE AFC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VORONOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-293-4594
Mailing Address - Street 1:277 LINDEN ST # 200
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5900
Mailing Address - Country:US
Mailing Address - Phone:617-293-4594
Mailing Address - Fax:
Practice Address - Street 1:277 LINDEN ST # 200
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5900
Practice Address - Country:US
Practice Address - Phone:617-293-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency