BRENDA SUE MATHIS NPI 1215261086

NPI Information

NPI: 1215261086
Provider Name: BRENDA SUE MATHIS

Doing Business As: BRENDA SUE MATHIS

Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
4034 W ROANOKE PL
BROKEN ARROW, OK
ZIP 74011
Phone: (918) 698-7171
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BRENDA SUE MATHIS is a community based residential treatment facility mental illness in Broken Arrow, OK. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. BRENDA SUE MATHIS NPI is 1215261086. The provider is registered as an organization entity type.
The provider Is Doing Business As Brenda Sue Mathis.

The provider's business location address is:

4034 W ROANOKE PL
BROKEN ARROW, OK
ZIP 74011-327
Phone: (918) 698-7171

The provider's authorized official is Brenda Sue Mathis .
The authorized official title is Owner and has the following contact phone number (918) 698-7171.

The enumeration date for this NPI number is 9/28/2009 and was last updated on 9/28/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License State	Primary
1	323P00000X	Psychiatric Residential Treatment Facility	OKLAHOMA	No
2	324500000X	Substance Abuse Rehabilitation Facility	OKLAHOMA	No
3	320800000X	Community Based Residential Treatment Facility, Mental Illness	OKLAHOMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	=========	MEDICARE UPIN	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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