| Soulcare Health, Llc | |
|
250 Constitution Blvd Lawrenceville GA 30046-8432 | |
| (470) 844-0157 | |
| (678) 539-8899 |
| Full Name | Soulcare Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 250 Constitution Blvd, Lawrenceville, Georgia |
| Authorized Official Name and Position | Glory O Osadiaye (PMHNP) |
| Authorized Official Contact | 6789784151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soulcare Health, Llc 780 Martin Field Dr Lawrenceville GA 30045-5270 Ph: (678) 978-4151 | Soulcare Health, Llc 250 Constitution Blvd Lawrenceville GA 30046-8432 Ph: (470) 844-0157 |
| NPI Number | 1851098651 |
|---|---|
| Provider Enumeration Date | 02/13/2023 |
| Last Update Date | 05/26/2023 |
| Certification Date | 05/26/2023 |
| Medicare PECOS PAC ID | 8527424332 |
|---|---|
| Medicare Enrollment ID | O20230522001830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851098651 | NPI | - | NPPES |
| Provider Name | Glory Osadiaye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003490764 PECOS PAC ID: 7517334295 Enrollment ID: I20221109002437 |
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