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Organization

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Active
Other names
Oakridge
Organization subpart
No

Provider details

NPI number
Authorized official
MR. TREY E WEAVER (FINANCE DIRECTOR)
(712) 277-8295
Entity
Organization

Contact information

Practice address
2007 RAVENS CT, SIOUX CITY, IA 51104-1762
(712) 277-8295
(712) 277-8602
Mailing address
3439 GLEN OAKS BLVD, SIOUX CITY, IA 51104-1761
(712) 277-8295
(712) 277-8602

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
315P00000X
Intellectual Disabilities Intermediate Care Facility
0881417
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0881417
IA
Enumeration date
02/08/2007
Last updated
09/22/2023
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