Provider Demographics
NPI:1992345821
Name:SOUL HEALTHY CARE LLC
Entity type:Organization
Organization Name:SOUL HEALTHY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-512-0582
Mailing Address - Street 1:7 RESERVOIR RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5501
Mailing Address - Country:US
Mailing Address - Phone:617-512-0582
Mailing Address - Fax:
Practice Address - Street 1:7 RESERVOIR RD STE 2
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5501
Practice Address - Country:US
Practice Address - Phone:617-512-0582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty