Provider Demographics
NPI:1306082169
Name:SOTO ASSISTED LIVING GROUP, INC.
Entity type:Organization
Organization Name:SOTO ASSISTED LIVING GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-426-4200
Mailing Address - Street 1:3736 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2360
Mailing Address - Country:US
Mailing Address - Phone:706-426-4200
Mailing Address - Fax:706-426-4201
Practice Address - Street 1:3736 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2360
Practice Address - Country:US
Practice Address - Phone:706-426-4200
Practice Address - Fax:706-426-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA231152062QMedicaid
GA231152062RMedicaid
GA231152062WMedicaid
GA231152062AAMedicaid
GA231152062KMedicaid
GA231152062OMedicaid
GA231152062TMedicaid
GA231152062LMedicaid
GA231152062ZMedicaid
GA231152062AMedicaid
GA231152062ADMedicaid
GA231152062JMedicaid
GA231152062PMedicaid
GA231152062FMedicaid
GA231152062IMedicaid
GA231152062MMedicaid
GA231152062SMedicaid
GA231152062UMedicaid
GA231152062AFMedicaid
GA231152062DMedicaid
GA231152062HMedicaid
GA231152062NMedicaid
GA231152062ABMedicaid
GA231152062AEMedicaid
GA231152062EMedicaid
GA231152062VMedicaid
GA231152062BMedicaid