Healthcare Provider Details

I. General information

NPI: 1205051323
Provider Name (Legal Business Name): TRC THE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 NW 25TH ST.
OKLAHOMA CITY OK
73106
US

IV. Provider business mailing address

1215 NW 25TH ST.
OKLAHOMA CITY OK
73106
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-2525
  • Fax: 405-524-3549
Mailing address:
  • Phone: 405-525-2525
  • Fax: 405-525-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVE MEHTA
Title or Position: CEO
Credential:
Phone: 405-525-2525