Organization
GRAND LAKE MENTAL HEALTH CENTER, INC.
Active
Other names
Grand Lake Medical Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY SMITH (CEO)
(918) 273-1841
Entity
Organization
Contact information
Practice address
17599 S HIGHWAY 88, CLAREMORE, OK 74017-0801
(918) 273-1841
(918) 273-1843
Mailing address
114 W DELAWARE AVE, NOWATA, OK 74048-2601
(918) 273-1841
(918) 273-1841
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100732860C
—
OK
Enumeration date
08/04/2006
Last updated
07/31/2020
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