Provider Demographics
NPI:1548487473
Name:AFRICAN AND AMERICAN HEALTHCARE FOUNDATION
Entity type:Organization
Organization Name:AFRICAN AND AMERICAN HEALTHCARE FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORANEFO
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-870-5501
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37116-0607
Mailing Address - Country:US
Mailing Address - Phone:615-870-5501
Mailing Address - Fax:615-870-5503
Practice Address - Street 1:801 E OLD HICKORY BLVD
Practice Address - Street 2:SUITES 160 & 171
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4169
Practice Address - Country:US
Practice Address - Phone:615-870-5501
Practice Address - Fax:615-870-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL3(20)4M5-027-3711251S00000X
TNI000000005310261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health