Provider Demographics
NPI:1326100066
Name:SOREO IN HOME SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:SOREO IN HOME SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-881-4477
Mailing Address - Street 1:1632 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3119
Mailing Address - Country:US
Mailing Address - Phone:520-881-4477
Mailing Address - Fax:866-260-0342
Practice Address - Street 1:1632 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3119
Practice Address - Country:US
Practice Address - Phone:520-881-4477
Practice Address - Fax:866-260-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ500000Medicaid