Organization
PENNINGTON CREEK LIFE HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN OWENS (OWNER)
(580) 371-3776
Entity
Organization
Contact information
Practice address
801 E MAIN ST, TISHOMINGO, OK 73460-2351
(580) 371-3776
Mailing address
801 EAST MAIN STREET, TISHOMINGO, OK 73460
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/04/2012
Last updated
09/04/2012
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