Provider Demographics
NPI:1124700075
Name:SOMALI DEVELOPMENT CENTER
Entity type:Organization
Organization Name:SOMALI DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDDIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-203-7923
Mailing Address - Street 1:10 MALCOLM X BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1775
Mailing Address - Country:US
Mailing Address - Phone:617-522-0700
Mailing Address - Fax:
Practice Address - Street 1:10 MALCOLM X BLVD FL 2ND
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1775
Practice Address - Country:US
Practice Address - Phone:617-522-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management