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General NPI Number Information
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NPI Number | 1265608236
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Entity Type | Organization
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Legal Business Name | SOPHIA SNOW HOUSE, INC.
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 1215 CENTRE ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-7701
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Country | US
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Telephone | 617-325-7900
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Fax | 617-325-6293
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Provider Business Mailing Address
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Address Line | 1215 CENTRE ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-7701
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Country | US
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Telephone | 617-325-7900
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Fax | 617-325-6293
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JUDY JOSE-RODDY
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Credential |
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Telephone | 671-325-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | 1041
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License Number State | MA
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