Healthcare Provider Details

I. General information

NPI: 1013564319
Provider Name (Legal Business Name): LANDMARK RECOVERY OF OKLAHOMA CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 NW 23RD ST
OKLAHOMA CITY OK
73127-1800
US

IV. Provider business mailing address

4835 E CACTUS RD STE 130
SCOTTSDALE AZ
85254-3545
US

V. Phone/Fax

Practice location:
  • Phone: 480-296-8619
  • Fax:
Mailing address:
  • Phone: 480-296-8619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BROOKE ZIMMERMAN
Title or Position: DIRECTOR
Credential:
Phone: 480-296-8619