Provider Demographics
NPI:1033289764
Name:THE REDCO GROUP, LLC.
Entity Type:Organization
Organization Name:THE REDCO GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-628-5215
Mailing Address - Street 1:210 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3501
Mailing Address - Country:US
Mailing Address - Phone:570-628-5215
Mailing Address - Fax:
Practice Address - Street 1:210 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3501
Practice Address - Country:US
Practice Address - Phone:570-628-5215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA203110261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000017170169Medicaid