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PENNINGTON CREEK LIFEHOUSE NPI 1831464304


NPI Information

NPI: 1831464304
Provider Name: PENNINGTON CREEK LIFEHOUSE
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
801 E MAIN ST
TISHOMINGO, OK
ZIP 73460
Phone: (580) 371-3799
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PENNINGTON CREEK LIFEHOUSE is a community behavioral health in Tishomingo, OK. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. PENNINGTON CREEK LIFEHOUSE NPI is 1831464304. The provider is registered as an organization entity type.

The provider's business location address is:

801 E MAIN ST
TISHOMINGO, OK
ZIP 73460-351
Phone: (580) 371-3799
Fax: (580) 371-2056

The provider's authorized official is Jan Owens .
The authorized official title is Owner and has the following contact phone number (580) 371-3799.

The enumeration date for this NPI number is 3/16/2012 and was last updated on 3/16/2012.


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 Taxonomy Specialization License Number License State Primary
1251S00000XCommunity/Behavioral HealthYes

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
1200226970MEDICARE PINOKLAHOMA

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: 5/5/2024

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