Healthcare Provider Details

I. General information

NPI: 1245913722
Provider Name (Legal Business Name): TRC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 NW 25TH ST
OKLAHOMA CITY OK
73106-5629
US

IV. Provider business mailing address

1215 NW 25TH ST
OKLAHOMA CITY OK
73106-5629
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-2525
  • Fax:
Mailing address:
  • Phone: 405-525-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DARA LEA
Title or Position: HR
Credential:
Phone: 405-525-2525