Provider Demographics
NPI:1952025983
Name:SOAR - SEEING OUR ADOLESCENTS RISE
Entity Type:Organization
Organization Name:SOAR - SEEING OUR ADOLESCENTS RISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-675-7761
Mailing Address - Street 1:PO BOX 461496
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80046-1496
Mailing Address - Country:US
Mailing Address - Phone:720-675-7761
Mailing Address - Fax:
Practice Address - Street 1:4155 E JEWELL AVE STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4509
Practice Address - Country:US
Practice Address - Phone:720-675-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1447892740Medicaid