Healthcare Provider Details

I. General information

NPI: 1457356560
Provider Name (Legal Business Name): TULSA COUNTY JUVENILE JUSTICE TRUST AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 E 35TH ST
TULSA OK
74135-4528
US

IV. Provider business mailing address

4012 E 35TH ST
TULSA OK
74135-4528
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-6668
  • Fax: 918-748-8814
Mailing address:
  • Phone: 918-749-6668
  • Fax: 918-748-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberK8500188
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberK8500187
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberK8500186
License Number StateOK

VIII. Authorized Official

Name: MR. ERIC SACHAU
Title or Position: CEO
Credential:
Phone: 918-749-6668