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Organization
SUGAR MOUNTAIN RETREAT, INC.
Active
Organization
SUGAR MOUNTAIN RETREAT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVETTA MCINTOSH (ADMINISTRATOR)
(918) 457-4221
Entity
Organization
Contact information
Practice address
26403 S 581 RD, WELLING, OK 74471-2303
(918) 457-4221
Mailing address
26403 S 581 RD, WELLING, OK 74471-2303
(918) 456-1010
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
RC 0201-0201
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RC 0201-0201
STATE LICENSE
OK
Enumeration date
03/07/2007
Last updated
08/22/2020
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