=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366689705
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLIS HEALTHCARE, LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2009
-----------------------------------------------------
Last Update Date | 03/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5800 RIDGE AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19128-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-509-6800
-----------------------------------------------------
Fax | 215-509-6830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5800 RIDGE AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19128-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-509-6800
-----------------------------------------------------
Fax | 215-509-6830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. ROBERT G. SOUAID
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-487-4207
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 910401
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------