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Organization

SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC

Active
Organization subpart
No

Provider details

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

Contact information

Practice address
6262 S SHERIDAN RD, TULSA, OK 74133-4055
(918) 492-8200
Mailing address
6262 S SHERIDAN RD, TULSA, OK 74133-4055
(918) 492-8200

Taxonomy

Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
2240
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2240
HOSPITAL LICENSE NUMBER
OK
Enumeration date
03/29/2014
Last updated
03/29/2014
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