Provider Demographics
NPI:1558805515
Name:RECOVERY IN OKLAHOMA LLC
Entity type:Organization
Organization Name:RECOVERY IN OKLAHOMA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GOOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHATTO JOSLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-591-3071
Mailing Address - Street 1:9179 S 256TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-5536
Mailing Address - Country:US
Mailing Address - Phone:918-928-7303
Mailing Address - Fax:
Practice Address - Street 1:4835 S FULTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6976
Practice Address - Country:US
Practice Address - Phone:918-591-3071
Practice Address - Fax:918-615-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-11
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center