Healthcare Provider Details

I. General information

NPI: 1659726081
Provider Name (Legal Business Name): SOJOURNER HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 SMITH ST
PROVIDENCE RI
02908-3727
US

IV. Provider business mailing address

386 SMITH ST
PROVIDENCE RI
02908-3727
US

V. Phone/Fax

Practice location:
  • Phone: 401-861-6191
  • Fax: 401-861-6157
Mailing address:
  • Phone: 401-861-6191
  • Fax: 401-861-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA VOLZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-861-6191