Provider Demographics
NPI:1669231403
Name:SILVER SOULS LLC
Entity type:Organization
Organization Name:SILVER SOULS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-619-1454
Mailing Address - Street 1:2109 BIG TREE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-3279
Mailing Address - Country:US
Mailing Address - Phone:614-619-1454
Mailing Address - Fax:
Practice Address - Street 1:2109 BIG TREE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3279
Practice Address - Country:US
Practice Address - Phone:614-619-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization