Basic Information
| Provider Information | |||||||||
| NPI: | 1457517872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PALMER CONTINUUM OF CARE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 711 S. SHERIDAN RD. | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188327764 | ||||||||
| FaxNumber: | 9188327765 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 S. SHERIDAN RD. | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188327764 | ||||||||
| FaxNumber: | 9188327765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2008 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SNEED | ||||||||
| AuthorizedOfficialFirstName: | GREG | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXCUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9188327764 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 3SRB71 | 05 | OK | MEDICAID |