Provider Demographics
NPI:1497731137
Name:REDCO GROUP, LLC
Entity Type:Organization
Organization Name:REDCO GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
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 1:10 BUIST RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9311
Mailing Address - Country:US
Mailing Address - Phone:570-296-1138
Mailing Address - Fax:570-296-3032
Practice Address - Street 1:10 BUIST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9311
Practice Address - Country:US
Practice Address - Phone:570-296-1138
Practice Address - Fax:570-296-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA206880261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000017170569Medicaid
PA197009Medicare Oscar/Certification