Provider Demographics
NPI:1376863043
Name:SOAR CORP
Entity Type:Organization
Organization Name:SOAR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAMPLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-931-1217
Mailing Address - Street 1:33 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2730
Mailing Address - Country:US
Mailing Address - Phone:610-622-1114
Mailing Address - Fax:
Practice Address - Street 1:33 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050
Practice Address - Country:US
Practice Address - Phone:610-622-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOAR CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-04
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PA237089261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020553790004Medicaid