Provider Demographics
NPI:1407640634
Name:SOLDIER ON INC.
Entity type:Organization
Organization Name:SOLDIER ON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-588-1180
Mailing Address - Street 1:3525 QUAKERBRIDGE RD STE 906
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1266
Mailing Address - Country:US
Mailing Address - Phone:413-588-1180
Mailing Address - Fax:
Practice Address - Street 1:275 ESSEX RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-7863
Practice Address - Country:US
Practice Address - Phone:413-588-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty