Provider Demographics
NPI:1154714327
Name:SHASHAMANE ETHIOPIA FEDERAL AGENTS ASSOCIATION (THE)
Entity type:Organization
Organization Name:SHASHAMANE ETHIOPIA FEDERAL AGENTS ASSOCIATION (THE)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON M.
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD EX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-765-2230
Mailing Address - Street 1:405 LEXINGTON AVE
Mailing Address - Street 2:CHRYSLER BUILDING 25TH & 26TH FLOORS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10174-0002
Mailing Address - Country:US
Mailing Address - Phone:202-765-2230
Mailing Address - Fax:877-490-3078
Practice Address - Street 1:2157 W 31ST ST # 2161
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-3424
Practice Address - Country:US
Practice Address - Phone:202-765-2230
Practice Address - Fax:877-490-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No174M00000XOther Service ProvidersVeterinarianGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)