Basic Information
| Provider Information | |||||||||
| NPI: | 1710985064 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 707001 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741707001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185028010 | ||||||||
| FaxNumber: | 9185028002 | ||||||||
| Practice Location | |||||||||
| Address1: | 6655 S YALE AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184814000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | RENEE | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, PATIENT FINANCIAL SERVICE | ||||||||
| AuthorizedOfficialTelephone: | 9185028010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | OK | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100700380C | 05 | OK | MEDICAID | 100700380N | 01 | OK | MEDICAID 1500 | OTHER | 100700380B | 01 | OK | MEDICAID INPATIENT | OTHER | 100700380D | 01 | OK | MEDICAID DVSD | OTHER | CC6784 | 01 | OK | MEDICARE RAILROAD | OTHER |