Organization
HELEN FARRIS
Active
Other names
GREEN ACRES RESIDENTIAL CARE HOME
Organization subpart
No
Provider details
NPI number
Authorized official
HELEN FARRIS (ADMINISTRATOR)
(918) 456-0704
Entity
Organization
Contact information
Practice address
17963 S 543 ROAD, TAHLEQUAH, OK 74464
(918) 456-8677
Mailing address
PO BOX 807, TAHLEQUAH, OK 74465-0807
(918) 456-0704
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
RC-1101-1101
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RC-1101-1101
STATE LICENSE
OK
Enumeration date
03/08/2007
Last updated
07/29/2008
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