Healthcare Provider Details

I. General information

NPI: 1306964077
Provider Name (Legal Business Name): SEQUEL OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N MARTIN LUTHER KING AVENUE
OKLAHOMA CITY OK
73111-4216
US

IV. Provider business mailing address

3301 N MARTIN LUTHER KING AVENUE
OKLAHOMA CITY OK
73111-4216
US

V. Phone/Fax

Practice location:
  • Phone: 405-548-1280
  • Fax: 405-548-1299
Mailing address:
  • Phone: 405-548-1280
  • Fax: 405-548-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberK850000367
License Number StateOK

VIII. Authorized Official

Name: MS. DIANE E. BEDELL
Title or Position: EXECUTIVE DIRECTOR/DON
Credential: RN MS
Phone: 405-417-3341