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General NPI Number Information
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NPI Number | 1134704489
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Entity Type | Organization
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Legal Business Name | TAHLEQUAH MEN'S SHELTER DBA PROJECT OSIYO
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 118 W KEETOOWAH ST
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City | TAHLEQUAH
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State | OK
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Zip | 74464-3820
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Country | US
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Telephone | 918-708-2015
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Fax |
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Provider Business Mailing Address
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Address Line | 118 W KEETOOWAH ST
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City | TAHLEQUAH
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State | OK
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Zip | 74464-3820
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Country | US
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Telephone | 918-708-2015
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Fax |
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Authorized Official
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Title or Position | BOARD PRESIDENT
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Name | SAM BRADSHAW
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Credential | LSW
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Telephone | 918-708-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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