Healthcare Provider Details

I. General information

NPI: 1922127323
Provider Name (Legal Business Name): LIFE SENIOR SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 E 31ST ST
TULSA OK
74135-5114
US

IV. Provider business mailing address

5950 E 31ST ST
TULSA OK
74135-5114
US

V. Phone/Fax

Practice location:
  • Phone: 918-664-9000
  • Fax: 918-665-0830
Mailing address:
  • Phone: 918-664-9000
  • Fax: 918-665-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDC7211-7211
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDC7210-7210
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDC7204-7204
License Number StateOK

VIII. Authorized Official

Name: MR. BILLY EARL COPELAND
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 918-938-7606