# SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shadow Mountain Behavioral Health System Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316091457
- **Authorized official:** MIKE KISTLER (CEO)
- **Authorized official phone:** (918) 492-8200

## Contact information

- **Practice address:** 1027 E 66TH PL, TULSA, OK 74136-3701
- **Practice address phone:** (918) 293-2552
- **Mailing address:** 1027 E 66TH PL, TULSA, OK 74136-3701
- **Mailing address phone:** (918) 293-2552

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | K8500227 | OK | Yes |

## Other

- **Enumeration date:** 01/23/2007
- **Last updated:** 03/30/2010