| Soar Corp | |
|
9150 Marshall St Suite 2 Philadelphia PA 19114 | |
| (215) 464-4450 | |
| (215) 464-4405 |
| Full Name | Soar Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 9150 Marshall St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Mark Shvartsburd (CEO/PROGRAM SPONSOR) |
| Authorized Official Contact | 2153226590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soar Corp 9150 Marshall St Ste 18 Philadelphia PA 19114-2217 Ph: (215) 464-4450 | Soar Corp 9150 Marshall St Suite 2 Philadelphia PA 19114 Ph: (215) 464-4450 |
| NPI Number | 1023287711 |
|---|---|
| Provider Enumeration Date | 02/27/2008 |
| Last Update Date | 08/14/2018 |
| Medicare PECOS PAC ID | 2961802723 |
|---|---|
| Medicare Enrollment ID | O20210616000012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023287711 | NPI | - | NPPES |
| 1020553790001 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QM2800X | Clinic/center - Methadone | 807405 (Pennsylvania) | Primary |
| Provider Name | Daryl Carl Watson |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1912926718 PECOS PAC ID: 4183620917 Enrollment ID: I20061018000217 |
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