Provider Demographics
NPI:1568157279
Name:SOFT LIFE THERAPEUTICS LLC
Entity Type:Organization
Organization Name:SOFT LIFE THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-895-4573
Mailing Address - Street 1:325 BROWN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4234
Mailing Address - Country:US
Mailing Address - Phone:804-895-4573
Mailing Address - Fax:
Practice Address - Street 1:325 BROWN ST STE 112
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4234
Practice Address - Country:US
Practice Address - Phone:804-895-4573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health