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NPI Code Detail

MEDICARE: ATHENA REHBILITATION SERVICES, LLC

MEDICARE: ATHENA REHBILITATION SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility12457565OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112455678OTHEROKSTATE LICENSE MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

General Provider Information

NPI Number : 1780058560
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATHENA REHBILITATION SERVICES, LLC
Provider Business Mailing Address
First Line : 24962 OKAY RD
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-6504
Country : US
Telephone Number : 405-550-1750
Fax Number : 405-589-8227
Provider Business Practice Location Address
First Line : 24962 OKAY RD
Second Line :
City : TECUMSEH
State : OK
Zip : 74873-6504
Country : US
Telephone Number : 405-550-1750
Fax Number : 405-589-8227
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : KAREN WALKER
Credential :
Telephone Number : 405-550-1750
Provider Enumeration Date : 11/17/2015
Last Update Date : 11/17/2015

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Directions to “ATHENA REHBILITATION SERVICES, LLC ” Practice Location

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