NPI 1306250675

Genesis

Organisation Physical Disabilities Residential Treatment Facility Broken Arrow, OK

Practice location

Address: 17110 E 51st St, Broken Arrow, OK 74012-9279
Phone: (918) 851-0737
Mailing address: 17110 E 51st Street, Broken, OK 74012

Authorised official

Name: Joella Escoe
Title: Occupational Therapy
Phone: (918) 851-0737

Registered specialties (3)

Physical Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320700000X Licence 280 (OK)

Other Residential Treatment Facility, Physical Disabilities providers in Oklahoma →

Nursing Facility/Intermediate Care Facility

Nursing & Custodial Care Facilities Taxonomy 313M00000X Licence 280 (OK)

Other Nursing Facility/Intermediate Care Facility providers in Oklahoma →

Intellectual and/or Developmental Disabilities Residential Treatment Facility

Residential Treatment Facilities Taxonomy 320600000X Licence OA280 (OK)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Oklahoma →

Registry record

NPI: 1306250675
Entity type: Organization
NPI issued: 16 Jun 2014
Record last updated: 16 Jun 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.