# HELEN FARRIS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GREEN ACRES RESIDENTIAL CARE HOME
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134250731
- **Authorized official:** HELEN FARRIS (ADMINISTRATOR)
- **Authorized official phone:** (918) 456-0704

## Contact information

- **Practice address:** 17963 S 543 ROAD, TAHLEQUAH, OK 74464
- **Practice address phone:** (918) 456-8677
- **Mailing address:** PO BOX 807, TAHLEQUAH, OK 74465-0807
- **Mailing address phone:** (918) 456-0704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3104A0625X | Assisted Living Facility (Mental Illness) | RC-1101-1101 | OK | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 07/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | RC-1101-1101 | STATE LICENSE | OK |