PEAK MEDICAL OKLAHOMA NO. 12 INC. NPI 1851346142

NPI Information

NPI: 1851346142
Provider Name: PEAK MEDICAL OKLAHOMA NO. 12, INC.

Doing Business As: LAKE DRIVE HOME

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
600 LAKE RD
HENRYETTA, OK
ZIP 74437
Phone: (918) 652-8101
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PEAK MEDICAL OKLAHOMA NO. 12, INC. is an intermediate care facility mentally retarded in Henryetta, OK. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PEAK MEDICAL OKLAHOMA NO. 12, INC. NPI is 1851346142. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Drive Home.

The provider's business location address is:

600 LAKE RD
HENRYETTA, OK
ZIP 74437-415
Phone: (918) 652-8101
Fax: (918) 652-8209

The provider's authorized official is William A. Mathies .
The authorized official title is President Director and has the following contact phone number (505) 821-3355.

The enumeration date for this NPI number is 5/24/2006 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	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		NH56055605	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	100779100A	MEDICAID	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: 5/5/2024

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