Provider Demographics
NPI:1013327774
Name:SOAR BEHAVIOR SERVICES, INC.
Entity Type:Organization
Organization Name:SOAR BEHAVIOR SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, MA, BCBA
Authorized Official - Phone:657-217-0966
Mailing Address - Street 1:PO BOX 4154
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-4154
Mailing Address - Country:US
Mailing Address - Phone:657-217-0966
Mailing Address - Fax:
Practice Address - Street 1:1764 E COMMONWEALTH AVE
Practice Address - Street 2:UNIT 104
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4818
Practice Address - Country:US
Practice Address - Phone:657-217-0966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-04
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty