Healthcare Provider Details

I. General information

NPI: 1295869089
Provider Name (Legal Business Name): SOUTHWEST BOSTON SENIOR SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 AMORY ST
JAMAICA PLAIN MA
02130-2652
US

IV. Provider business mailing address

555 AMORY ST
JAMAICA PLAIN MA
02130-2652
US

V. Phone/Fax

Practice location:
  • Phone: 617-522-6700
  • Fax: 617-524-2899
Mailing address:
  • Phone: 617-522-6700
  • Fax: 617-524-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE P. MITCHELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 617-522-6700