Provider Demographics
NPI:1821020421
Name:SOLIS HEALTHCARE, LP
Entity Type:Organization
Organization Name:SOLIS HEALTHCARE, LP
Other - Org Name:ROXBOROUGH MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:215-487-4245
Mailing Address - Street 1:5800 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1737
Mailing Address - Country:US
Mailing Address - Phone:215-487-4245
Mailing Address - Fax:215-487-4274
Practice Address - Street 1:5800 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1737
Practice Address - Country:US
Practice Address - Phone:215-487-4245
Practice Address - Fax:215-487-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
PA910401282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
09801OtherHEALTH PARTNERS
1430OtherAETNA US HEALTHCARE
PA1019096660001Medicaid
390304B000000OtherSECTION 1011
1757000OtherKEYSTONE HEALTH PLAN EAST
318955OtherPACIFICARE
9801OtherHEALTH PARTNERS
NJ0062197Medicaid
KY1500883Medicaid
30042522OtherKEYSTONE MERCY HEALTH PLA
SC11056AMedicaid
PA0005633000OtherINDEPENDENCE BLUE CROSS
PA39-0304Medicare PIN