Provider Demographics
NPI:1124100235
Name:THE REDCO GROUP, LLC.
Entity type:Organization
Organization Name:THE REDCO GROUP, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-628-5234
Mailing Address - Street 1:16 S. CENTRE ST.
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901
Mailing Address - Country:US
Mailing Address - Phone:570-628-5234
Mailing Address - Fax:570-628-5299
Practice Address - Street 1:16 SOUTH CENTRE STREET
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2810
Practice Address - Country:US
Practice Address - Phone:570-628-5234
Practice Address - Fax:570-628-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000017170545Medicaid
197009Medicare Oscar/Certification