| NPI | 1215261086 |
|---|---|
| Doing Business As | BRENDA SUE MATHIS |
| Entity Type | Organization |
| Authorized Contact | BRENDA SUE MATHIS Owner 918-698-7171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 323P00000X Psychiatric Residential Treatment Facility |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2009-09-28 |