Organization
SOPHISTICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILICIA CAILLOT (CEO)
(617) 905-0428
Entity
Organization
Contact information
Practice address
1403 LINDSAY AVE, PORTSMOUTH, VA 23704-6917
(617) 905-0428
Mailing address
1403 LINDSAY AVE, PORTSMOUTH, VA 23704-6917
(617) 905-0428
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/07/2024
Last updated
03/07/2024
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