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Organization

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC

Active
Other names
Shadow Mountain Behavioral Health System Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
MIKE KISTLER (CEO)
(918) 492-8200
Entity
Organization

Contact information

Practice address
1027 E 66TH PL, TULSA, OK 74136-3701
(918) 293-2552
Mailing address
1027 E 66TH PL, TULSA, OK 74136-3701
(918) 293-2552

Taxonomy

Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
K8500227
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200006820Q
OK
Enumeration date
01/23/2007
Last updated
03/30/2010
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