Provider Demographics
NPI:1659118933
Name:SOULVATION FARMS
Entity type:Organization
Organization Name:SOULVATION FARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CRS
Authorized Official - Phone:570-229-7320
Mailing Address - Street 1:420 S EDWARDS CT
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2876
Mailing Address - Country:US
Mailing Address - Phone:570-229-7320
Mailing Address - Fax:
Practice Address - Street 1:418 S EDWARDS CT
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2876
Practice Address - Country:US
Practice Address - Phone:570-229-7320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health