Healthcare Provider Details

I. General information

NPI: 1528122355
Provider Name (Legal Business Name): ARBUCKLE LIFE SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 10TH AVE NW
ARDMORE OK
73401-5929
US

IV. Provider business mailing address

9 10TH AVE NW
ARDMORE OK
73401-5929
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-1656
  • Fax: 844-270-7511
Mailing address:
  • Phone: 580-226-1656
  • Fax: 844-270-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. KEVIN ANTHONY BONE
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, LPC, LADC/MH
Phone: 580-226-1656