Healthcare Provider Details

I. General information

NPI: 1841418514
Provider Name (Legal Business Name): MORNING STAR A.T.U.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 3 BOX 19
MARIETTA OK
73448-9604
US

IV. Provider business mailing address

PO BOX 500
MARIETTA OK
73448-0500
US

V. Phone/Fax

Practice location:
  • Phone: 580-276-5443
  • Fax: 580-276-5443
Mailing address:
  • Phone: 580-276-5443
  • Fax: 580-276-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateOK

VIII. Authorized Official

Name: MS. SARAH MILES COWAN
Title or Position: EXECUTIVE DIRECTOR - OWNER
Credential: B.S., LCDC, ADC-III
Phone: 58023765443