Provider Demographics
NPI:1023287711
Name:SOAR CORP
Entity type:Organization
Organization Name:SOAR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM SPONSOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHVARTSBURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-322-6590
Mailing Address - Street 1:9150 MARSHALL ST STE 18
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2217
Mailing Address - Country:US
Mailing Address - Phone:215-464-4450
Mailing Address - Fax:215-464-4405
Practice Address - Street 1:9150 MARSHALL ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-464-4450
Practice Address - Fax:215-464-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PA807405261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020553790001Medicaid