Provider Demographics
NPI:1043765621
Name:SOAR CORP
Entity Type:Organization
Organization Name:SOAR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANGANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-464-4450
Mailing Address - Street 1:9150 MARSHALL ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2217
Mailing Address - Country:US
Mailing Address - Phone:215-464-4450
Mailing Address - Fax:215-464-4470
Practice Address - Street 1:7500 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057
Practice Address - Country:US
Practice Address - Phone:215-464-4450
Practice Address - Fax:215-464-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PA261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102055379Medicaid