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Organization

LOVE GROW LIVE CENTER, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LESLIE M BURNSIDE (PROGRAM COORDINATOR)
(870) 415-9993
Entity
Organization

Contact information

Practice address
12000 N VIRGINIA AVE, OKLAHOMA CITY, OK 73120-7581
(405) 315-9790
Mailing address
12000 N VIRGINIA AVE, OKLAHOMA CITY, OK 73120-7581
(405) 315-9790

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
251S00000X
Community/Behavioral Health Agency
Primary
252Y00000X
Early Intervention Provider Agency
261QD1600X
Developmental Disabilities Clinic/Center

Other

Enumeration date
04/17/2023
Last updated
04/17/2023
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