1275679581 NPI number — RELIANT LIVING CENTERS OF OKLAHOMA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275679581 NPI number — RELIANT LIVING CENTERS OF OKLAHOMA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIANT LIVING CENTERS OF OKLAHOMA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RELIANT LIVING CENTERS OF DEL CITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275679581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3317 SE 18TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEL CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73115-1413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-677-2421
Provider Business Mailing Address Fax Number:
405-677-2497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3317 SE 18TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73115-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-677-2421
Provider Business Practice Location Address Fax Number:
405-677-2497
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLORENCE
Authorized Official First Name:
BILL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
405-677-2421

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  NH5547 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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