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General NPI Number Information
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NPI Number | 1740322130
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Entity Type | Organization
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Legal Business Name | ST. BOTOLPH ASSISTED LIVING LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 352 MASSACHUSETTS AVE
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City | BOSTON
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State | MA
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Zip | 02115-4950
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Country | US
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Telephone | 617-247-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 352 MASSACHUSETTS AVE
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City | BOSTON
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State | MA
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Zip | 02115-4950
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Country | US
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Telephone | 617-247-1010
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JEANNE FULLER-JONES
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Credential |
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Telephone | 617-247-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 1906127
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License Number State | MA
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