Healthcare Provider Details

I. General information

NPI: 1437615598
Provider Name (Legal Business Name): SOLASTA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 CHARLES ST
PROVIDENCE RI
02904-1337
US

IV. Provider business mailing address

765 CHARLES ST
PROVIDENCE RI
02904-1337
US

V. Phone/Fax

Practice location:
  • Phone: 866-880-1234
  • Fax: 866-880-1234
Mailing address:
  • Phone: 866-880-1234
  • Fax: 866-880-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANURAG SOOCH
Title or Position: CEO
Credential:
Phone: 866-880-1234