Healthcare Provider Details

I. General information

NPI: 1144505488
Provider Name (Legal Business Name): LIFE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W MATTHEWS AVE
STILLWATER OK
74075-7517
US

IV. Provider business mailing address

411 W MATTHEWS AVE
STILLWATER OK
74075-7517
US

V. Phone/Fax

Practice location:
  • Phone: 405-377-0978
  • Fax: 405-372-7726
Mailing address:
  • Phone: 405-377-0978
  • Fax: 405-372-7726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberDC6001-6001
License Number StateOK

VIII. Authorized Official

Name: KRISTY A MOORMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: TRS/L
Phone: 405-377-0978