1003234907 NPI number — SPRING OF LIFE FAMILY SERVICES LLC

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 1003234907 NPI number — SPRING OF LIFE FAMILY SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRING OF LIFE FAMILY SERVICES LLC
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:
Provider Other Organization Name Type Code:
6
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:
1003234907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7814 NORTHWEST 94TH, SUITE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKC
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73162-6201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-414-0043
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7814 NW 94TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73162-6203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-414-0043
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LANGE
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
KINYUY
Authorized Official Title or Position:
OWNER/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
405-414-0043

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  4942 , 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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