Organization
TAHLEQUAH MEN'S SHELTER DBA PROJECT OSIYO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM BRADSHAW LSW (BOARD PRESIDENT)
(918) 708-2015
Entity
Organization
Contact information
Practice address
118 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3820
(918) 708-2015
Mailing address
118 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3820
(918) 708-2015
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
Other
Enumeration date
03/17/2021
Last updated
03/17/2021
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