Provider Demographics
NPI:1124345590
Name:UHS OKLAHOMA CTIY, LLC
Entity type:Organization
Organization Name:UHS OKLAHOMA CTIY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:4056-056-1111
Mailing Address - Street 1:6501 NE 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73141-9118
Mailing Address - Country:US
Mailing Address - Phone:405-605-6111
Mailing Address - Fax:405-424-0457
Practice Address - Street 1:6501 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73141-9118
Practice Address - Country:US
Practice Address - Phone:405-605-6111
Practice Address - Fax:405-424-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKK8500000368323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200085660EMedicaid