Healthcare Provider Details

I. General information

NPI: 1164643409
Provider Name (Legal Business Name): PARKSIDE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S TRENTON AVE
TULSA OK
74120-5421
US

IV. Provider business mailing address

1239 S TRENTON AVE
TULSA OK
74120-5420
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-2131
  • Fax:
Mailing address:
  • Phone: 918-582-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ERIC SACHAU
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 918-588-8826