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General NPI Number Information
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NPI Number | 1588032635
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Entity Type | Organization
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Legal Business Name | RECOVERY IN OKLAHOMA LLC
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Dates
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Enumeration Date | 09/07/2015
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 215 S GRAND AVE STE A
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City | OKMULGEE
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State | OK
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Zip | 74447-4623
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Country | US
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Telephone | 918-777-3075
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Fax | 918-615-2261
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Provider Business Mailing Address
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Address Line | 9179 S 256TH EAST AVE
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City | BROKEN ARROW
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State | OK
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Zip | 74014-5536
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Country | US
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Telephone | 918-260-6080
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Fax | 918-615-2261
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GOOSE SHATTO JOSLIN
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Credential |
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Telephone | 918-591-3071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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