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General NPI Number Information
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NPI Number | 1689233777
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Entity Type | Organization
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Legal Business Name | SOAR FOR LIFE
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 1906 N JUNIATA ST
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-1908
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Country | US
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Telephone | 814-502-2502
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 N JUNIATA ST
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City | HOLLIDAYSBURG
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State | PA
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Zip | 16648-1908
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Country | US
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Telephone | 814-695-2984
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Fax | 814-695-2110
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Authorized Official
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Title or Position | OWNER
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Name | DANA MARIE MELTON
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Credential | RN, LCSW
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Telephone | 814-502-2502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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