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General NPI Number Information
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NPI Number | 1033794706
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Entity Type | Organization
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Legal Business Name | PATH OF WELLNESS LLC
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 993 SOUTH ST
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City | ROSLINDALE
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State | MA
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Zip | 02131-2307
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Country | US
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Telephone | 617-223-7183
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Fax |
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Provider Business Mailing Address
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Address Line | 993 SOUTH ST
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City | ROSLINDALE
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State | MA
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Zip | 02131-2307
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Country | US
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Telephone | 617-223-7183
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Fax |
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Authorized Official
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Title or Position | OWNER/VICE PRESIDENT/DON
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Name | SOPHIA MONTISSOL
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Credential |
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Telephone | 617-223-7183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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