Provider Demographics
NPI:1851098651
Name:SOULCARE HEALTH, LLC
Entity Type:Organization
Organization Name:SOULCARE HEALTH, LLC
Other - Org Name:SOULCARE HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:GLORY
Authorized Official - Middle Name:O
Authorized Official - Last Name:OSADIAYE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:678-978-4151
Mailing Address - Street 1:780 MARTIN FIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5270
Mailing Address - Country:US
Mailing Address - Phone:678-978-4151
Mailing Address - Fax:
Practice Address - Street 1:250 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8432
Practice Address - Country:US
Practice Address - Phone:470-844-0157
Practice Address - Fax:678-539-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health