Healthcare Provider Details

I. General information

NPI: 1043834849
Provider Name (Legal Business Name): PADDINGTON PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/15/2024
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 RACHEL STREET
BIXBY OK
74008
US

IV. Provider business mailing address

PO BOX 990
EDMOND OK
73083-0990
US

V. Phone/Fax

Practice location:
  • Phone: 918-290-3401
  • Fax: 539-302-9786
Mailing address:
  • Phone: 405-285-8166
  • Fax: 405-563-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT D PILGRIM
Title or Position: MANAGING MEMBER
Credential:
Phone: 405-285-8166