Organization
SOUL PUSH LLC
Active
Other names
soul push llc
Organization subpart
No
Provider details
NPI number
Authorized official
ALI FARHAN (OWNER)
(605) 824-8659
Entity
Organization
Contact information
Practice address
1038 BROADWAY ST NE, SALEM, OR 97301-1276
(605) 824-8659
Mailing address
1038 BROADWAY ST NE, SALEM, OR 97301-1276
(605) 824-8659
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
05/30/2025
Last updated
05/30/2025
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