Provider Demographics
NPI:1306243019
Name:GREEN COUNTRY REHABILITATION
Entity type:Organization
Organization Name:GREEN COUNTRY REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN- HARRIS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:405-517-8198
Mailing Address - Street 1:3535 NW 58TH ST STE 940
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4802
Mailing Address - Country:US
Mailing Address - Phone:405-605-1130
Mailing Address - Fax:405-605-1402
Practice Address - Street 1:3535 NW 58TH ST STE 940
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4802
Practice Address - Country:US
Practice Address - Phone:405-605-1130
Practice Address - Fax:405-605-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK597310400000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK9239OtherALL INSURANCE
OK9239OtherALL INSURANCE PROVIDERS