Organization
SORC, LLC
Active
Other names
SORC ReGrowth
Organization subpart
No
Provider details
NPI number
Authorized official
TRYNA SMOOT CDCA (OWNER/EXECUTIVE DIRECTOR)
(419) 378-9212
Entity
Organization
Contact information
Practice address
11811 NORTH FWY STE 100, HOUSTON, TX 77060-3244
(419) 378-9212
Mailing address
723 PHILLIPS AVE BLDG E, TOLEDO, OH 43612-1351
(419) 407-5981
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
13527
OH
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033536255
—
TX
05
—
1063629608
—
MI
05
—
1063629608
—
OH
05
—
1134667538
—
MI
05
—
1134667538
—
OH
05
—
1134667538
—
TX
05
—
1396076543
—
TX
05
—
4226219
—
TX
05
—
4234783
—
TX
Enumeration date
03/26/2014
Last updated
01/16/2022
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