Healthcare Provider Details

I. General information

NPI: 1780409987
Provider Name (Legal Business Name): SOAR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 HIGHWAY 70
TOMS RIVER NJ
08755-1026
US

IV. Provider business mailing address

2360 RT 9 STE 3, SUIT 102
TOMS RIVER NJ
08755-1933
US

V. Phone/Fax

Practice location:
  • Phone: 732-813-7627
  • Fax:
Mailing address:
  • Phone: 323-244-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BILL TEICHMAN
Title or Position: MEMBER
Credential:
Phone: 323-244-5176