Individual
MOHAMMED EISA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
759 BENNINGTON ST, 1, BOSTON, MA 02128-1133
(804) 873-6581
Mailing address
759 BENNINGTON ST, 1, BOSTON, MA 02128-1133
(804) 873-6581
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/22/2015
Last updated
09/22/2015
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