Healthcare Provider Details

I. General information

NPI: 1073103701
Provider Name (Legal Business Name): LIFEGATE FREEDOM RECOVERY MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11680 S 153RD WEST AVE
SAPULPA OK
74066-8564
US

IV. Provider business mailing address

11680 S 153RD WEST AVE
SAPULPA OK
74066-8564
US

V. Phone/Fax

Practice location:
  • Phone: 918-639-4684
  • Fax: 918-512-6320
Mailing address:
  • Phone: 918-512-6273
  • Fax: 918-512-6320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: RICHARD KEVIN DAY
Title or Position: CEO
Credential:
Phone: 918-639-4684