Healthcare Provider Details

I. General information

NPI: 1316922362
Provider Name (Legal Business Name): THE REDCO GROUP, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 10/11/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S CENTRE STREET SUITE 28
POTTSVILLE PA
17901
US

IV. Provider business mailing address

208 S CENTRE ST
POTTSVILLE PA
17901-3501
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-6417
  • Fax:
Mailing address:
  • Phone: 570-622-6417
  • Fax: 570-622-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number203110
License Number StatePA

VIII. Authorized Official

Name: MR. TIM SOHOSKY
Title or Position: COO
Credential:
Phone: 570-628-5215