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Organization
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC
Active
Organization
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC
Active
Other names
Shadow Mountain Behavioral Health System Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE KISTLER (CEO)
(918) 492-8200
Entity
Organization
Contact information
Practice address
1027 E 66TH PL, TULSA, OK 74136-3701
(918) 293-2552
Mailing address
1027 E 66TH PL, TULSA, OK 74136-3701
(918) 293-2552
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
K8500227
OK
Other
Enumeration date
01/23/2007
Last updated
03/30/2010
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