Healthcare Provider Details

I. General information

NPI: 1043765621
Provider Name (Legal Business Name): SOAR CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 BRISTOL PIKE
LEVITTOWN PA
19057
US

IV. Provider business mailing address

9150 MARSHALL ST SUITE 18
PHILADELPHIA PA
19114-2217
US

V. Phone/Fax

Practice location:
  • Phone: 215-464-4450
  • Fax: 215-464-4470
Mailing address:
  • Phone: 215-464-4450
  • Fax: 215-464-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RICHARD A MANGANO
Title or Position: VICE PRESIDENT
Credential:
Phone: 215-464-4450