1306082169 NPI number — SOTO ASSISTED LIVING GROUP, INC.

Table of content: (NPI 1306082169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306082169 NPI number — SOTO ASSISTED LIVING GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOTO ASSISTED LIVING GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOTO ALG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306082169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3736 EXECUTIVE CENTER DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30907-2360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-426-4200
Provider Business Mailing Address Fax Number:
706-426-4201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3736 EXECUTIVE CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30907-2360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-426-4200
Provider Business Practice Location Address Fax Number:
706-426-4201
Provider Enumeration Date:
12/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SOTO
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
706-426-4200

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 231152062Q , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062R , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062W , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062AA , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062O , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062T , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062Z , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062AD , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062P , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062S , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062U , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062AF , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 231152062D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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