Organization
OSAGE NATION PRT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS GRAY I NA (COORDINATOR)
(918) 287-5420
Entity
Organization
Contact information
Practice address
1011 GRANDVIEW AVE, PAWHUSKA, OK 74056-3023
(918) 287-5420
(918) 287-3721
Mailing address
5525 HARVARD DR, BARTLESVILLE, OK 74006-8838
(918) 287-5420
(918) 287-3721
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
109
OK
Other
Enumeration date
06/22/2012
Last updated
06/22/2012
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