Healthcare Provider Details

I. General information

NPI: 1972385672
Provider Name (Legal Business Name): BEHAVIORAL HEALTH PORTER VILLAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 WELLNESS WAY
NORMAN OK
73071
US

IV. Provider business mailing address

3905 HEDGCOXE RD UNIT 250249
PLANO TX
75025-0840
US

V. Phone/Fax

Practice location:
  • Phone: 405-754-1309
  • Fax: 405-753-5669
Mailing address:
  • Phone: 972-464-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: LAURA F. TARANTINO
Title or Position: EVP
Credential:
Phone: 972-464-0022