Provider Demographics
NPI:1265608236
Name:SOPHIA SNOW HOUSE, INC.
Entity type:Organization
Organization Name:SOPHIA SNOW HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE-RODDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-325-7900
Mailing Address - Street 1:1215 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-7701
Mailing Address - Country:US
Mailing Address - Phone:617-325-7900
Mailing Address - Fax:617-325-6293
Practice Address - Street 1:1215 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-7701
Practice Address - Country:US
Practice Address - Phone:617-325-7900
Practice Address - Fax:617-325-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility