Healthcare Provider Details

I. General information

NPI: 1376848051
Provider Name (Legal Business Name): NEW GENERATION THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E PEKIN AVE
MORRIS OK
74445-2233
US

IV. Provider business mailing address

105 E PEKIN AVE
MORRIS OK
74445-2233
US

V. Phone/Fax

Practice location:
  • Phone: 918-629-9570
  • Fax:
Mailing address:
  • Phone: 918-629-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateOK

VIII. Authorized Official

Name: MS. DONNA SUE MORGAN
Title or Position: OWNER
Credential:
Phone: 918-629-9570