NPIMap

Organization Active NPI

Redco Group, LLC

Doing business as Clarvida

  • Adolescent and Children Mental Health Clinic/Center
  • Pottsville, PA
National Provider Identifier
1245215268
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
209010 Issued in PA
Legal business name
REDCO GROUP, LLC
Doing business as
Clarvida
Practice address
16 S Centre St
Pottsville, PA 17901-3001
Phone
(570) 628-5234
Fax
(570) 628-9051
NPI assigned
Dec 13, 2005
Reactivated
Oct 7, 2020
Last updated
Jul 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Tim Sohosky
Title
Coo
Phone
(570) 628-5215

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 209010 PA Primary

Addresses

Primary practice location

16 S Centre St
Pottsville, PA 17901-3001

Mailing address

16 S Centre St
Pottsville, PA 17901-3001
Phone (570) 628-5234

Other identifiers 1

IdentifierTypeStateIssuer
1000017170155MedicaidPA

Other names 1

  • Clarvida Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Turning Point12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1245215268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 S CENTRE ST",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013001",
            "telephone_number": "570-628-5234",
            "fax_number": "570-628-9051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 S CENTRE ST",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013001",
            "telephone_number": "570-628-5234",
            "fax_number": "570-628-9051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDCO GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "deactivation_date": "2018-04-30",
        "reactivation_date": "2020-10-07",
        "status": "A",
        "authorized_official_last_name": "SOHOSKY",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "570-628-5215",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "PA",
            "license": "209010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000017170155",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarvida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pottsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.