Healthcare Provider Details

I. General information

NPI: 1962777128
Provider Name (Legal Business Name): SALATKA HALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 WEST TEXAS
OKARCHE OK
73762-0245
US

IV. Provider business mailing address

635 WEST TEXAS
OKARCHE OK
73762-0245
US

V. Phone/Fax

Practice location:
  • Phone: 405-263-7113
  • Fax: 405-263-7114
Mailing address:
  • Phone: 405-263-7113
  • Fax: 405-263-7114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberNH0910-0910
License Number StateOK

VIII. Authorized Official

Name: MR. JIM O'BRIEN SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-263-4658