Provider Demographics
NPI:1639867146
Name:SOLDAN COMMUNITY LIVING LLC
Entity Type:Organization
Organization Name:SOLDAN COMMUNITY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EFE
Authorized Official - Middle Name:DICK
Authorized Official - Last Name:DUVWAROVWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-266-0626
Mailing Address - Street 1:1190 W SAINT GEORGES AVE APT B23
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-6155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1190 W SAINT GEORGES AVE APT B23
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-6155
Practice Address - Country:US
Practice Address - Phone:908-266-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities