Healthcare Provider Details

I. General information

NPI: 1710228663
Provider Name (Legal Business Name): TRANSITIONS LIFECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/04/2015
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: 918-551-6879
  • Fax: 918-551-6890
Mailing address:
  • Phone: 918-551-6879
  • Fax: 918-551-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. JOSHUA HAVEN BRAZEAL
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 918-551-6879