1609297498 NPI number — SOVIA THERAPY, LLC

Table of content: (NPI 1609297498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609297498 NPI number — SOVIA THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOVIA THERAPY, LLC
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:
Provider Other Organization Name Type Code:
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:
1609297498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 TIVERTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17050-7699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-379-4543
Provider Business Mailing Address Fax Number:
717-732-3740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 TIVERTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17050-7699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-379-4543
Provider Business Practice Location Address Fax Number:
717-732-3740
Provider Enumeration Date:
12/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNDER
Authorized Official Telephone Number:
717-379-4543

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  OC002751L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1026813350002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1028563980001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019283190003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1022391420002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1025619720001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1025209420001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1028468290001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1027475710001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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