Provider Demographics
NPI:1104030402
Name:VALLIANT HOUSE, LLC
Entity type:Organization
Organization Name:VALLIANT HOUSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADC
Authorized Official - Phone:580-212-0625
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:VALLIANT
Mailing Address - State:OK
Mailing Address - Zip Code:74764-0673
Mailing Address - Country:US
Mailing Address - Phone:580-203-3600
Mailing Address - Fax:833-402-9799
Practice Address - Street 1:300 N. DALTON AVE
Practice Address - Street 2:
Practice Address - City:VALLIANT
Practice Address - State:OK
Practice Address - Zip Code:74764
Practice Address - Country:US
Practice Address - Phone:580-203-3600
Practice Address - Fax:833-402-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility