Healthcare Provider Details

I. General information

NPI: 1538145453
Provider Name (Legal Business Name): REDCO GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 MAIN ST SECOND FLOOR
STROUDSBURG PA
18360-2004
US

IV. Provider business mailing address

564 MAIN ST SECOND FLOOR
STROUDSBURG PA
18360-2004
US

V. Phone/Fax

Practice location:
  • Phone: 570-420-8070
  • Fax: 570-424-6487
Mailing address:
  • Phone: 570-420-8070
  • Fax: 570-424-6487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number206880
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StatePA

VIII. Authorized Official

Name: CASSI GROUP
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 412-495-4374