Provider Demographics
NPI:1316922362
Name:THE REDCO GROUP, LLC.
Entity type:Organization
Organization Name:THE REDCO GROUP, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-628-5215
Mailing Address - Street 1:208 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3501
Mailing Address - Country:US
Mailing Address - Phone:570-622-6417
Mailing Address - Fax:570-622-3230
Practice Address - Street 1:16 S CENTRE STREET
Practice Address - Street 2:SUITE 28
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901
Practice Address - Country:US
Practice Address - Phone:570-622-6417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
PA203110261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000017170571Medicaid
PA1000017170169Medicaid