1922127323 NPI number — LIFE SENIOR SERVICES, INC

Table of content: (NPI 1922127323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922127323 NPI number — LIFE SENIOR SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE SENIOR SERVICES, 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:
ADULT DAY SERVICES
Provider Other Organization Name Type Code:
5
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:
1922127323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5950 E 31ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74135-5114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-664-9000
Provider Business Mailing Address Fax Number:
918-665-0830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5950 E 31ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-664-9000
Provider Business Practice Location Address Fax Number:
918-665-0830
Provider Enumeration Date:
03/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COPELAND
Authorized Official First Name:
BILLY
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
918-938-7606

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  DC7204-7204 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QA0600X , with the licence number: DC7211-7211 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: DC7210-7210 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100681690C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100681690B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".