Healthcare Provider Details

I. General information

NPI: 1083854798
Provider Name (Legal Business Name): WOVENLIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NE 13TH ST
OKLAHOMA CITY OK
73104-5003
US

IV. Provider business mailing address

701 NE 13TH ST
OKLAHOMA CITY OK
73104-5003
US

V. Phone/Fax

Practice location:
  • Phone: 405-239-2525
  • Fax: 405-239-2278
Mailing address:
  • Phone: 405-239-2525
  • Fax: 405-239-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDC5512
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberDC5512-5512
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULA KRISTIN PORTER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 405-239-2525