Provider Demographics
NPI:1417602764
Name:SOCIAL HEALTH COMPANY
Entity Type:Organization
Organization Name:SOCIAL HEALTH COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ROTHSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-379-9946
Mailing Address - Street 1:2221 NE 164TH ST STE 296
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3703
Mailing Address - Country:US
Mailing Address - Phone:888-484-2466
Mailing Address - Fax:
Practice Address - Street 1:501 E LAS OLAS BLVD STE 222
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2882
Practice Address - Country:US
Practice Address - Phone:888-484-2466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy