Basic Information
| Provider Information | |||||||||
| NPI: | 1184347734 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOBAIR LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1213 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161052646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242340379 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1213 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161052646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7242340379 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2022 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| AuthorizedOfficialLastName: | DONNELLY | ||||||||
| AuthorizedOfficialFirstName: | JOHNNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | LPCC | ||||||||
| AuthorizedOfficialTelephone: | 7242340379 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPCC | ||||||||
| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.