Healthcare Provider Details

I. General information

NPI: 1588052476
Provider Name (Legal Business Name): TRANSITIONS LIFECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E 71ST ST SUITE 100
TULSA OK
74136-5046
US

IV. Provider business mailing address

1515 E 71ST ST SUITE 100
TULSA OK
74136-5046
US

V. Phone/Fax

Practice location:
  • Phone: 405-206-4680
  • Fax: 918-551-6890
Mailing address:
  • Phone: 405-206-4680
  • Fax: 918-551-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA HAVEN BRAZEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 405-206-4680