Provider Demographics
NPI:1639603111
Name:SOS RECOVERY SERVICES, INC.
Entity Type:Organization
Organization Name:SOS RECOVERY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:724-888-2186
Mailing Address - Street 1:234 ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074
Mailing Address - Country:US
Mailing Address - Phone:724-888-2186
Mailing Address - Fax:724-888-2443
Practice Address - Street 1:234 ADAMS ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-2102
Practice Address - Country:US
Practice Address - Phone:724-888-2186
Practice Address - Fax:724-888-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005628V363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1608286Medicaid
PA2891898OtherHIGHMARK KEYSTONE HEALTHPLAN WEST