1487904728 NPI number — GOLDEN HEART SENIOR CARE OF OKLAHOMA

Table of content: MS. PATRICIA CROSBY MED., LPC. (NPI 1386097517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487904728 NPI number — GOLDEN HEART SENIOR CARE OF OKLAHOMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN HEART SENIOR CARE OF OKLAHOMA
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:
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:
1487904728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 BROADWAY EXT STE 118
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73116-9045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-796-4848
Provider Business Mailing Address Fax Number:
405-607-4881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 BROADWAY EXT STE 118
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-9045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-796-4848
Provider Business Practice Location Address Fax Number:
405-607-4881
Provider Enumeration Date:
09/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
J
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
405-796-4848

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7999 , 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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