Provider Demographics
NPI:1275659260
Name:SOJOURNER HOUSE, INC.
Entity Type:Organization
Organization Name:SOJOURNER HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, PHD
Authorized Official - Phone:412-441-7783
Mailing Address - Street 1:5460 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3455
Mailing Address - Country:US
Mailing Address - Phone:412-441-7783
Mailing Address - Fax:412-441-3409
Practice Address - Street 1:5460 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3455
Practice Address - Country:US
Practice Address - Phone:412-441-7783
Practice Address - Fax:412-441-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA707160324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01741712Medicaid
PA707160OtherFACILITY ID