Organization · Type 2 NPI

Liberty of Oklahoma Corporation

Intellectual Disabilities Intermediate Care Facility · Tulsa, OK

NPI number 1104389006 Active

Practice location

7318 E Pine St
Tulsa, OK 74115-5743

Specialties and licenses

Taxonomy	Code	License
Intellectual Disabilities Intermediate Care Facility Primary	315P00000X	None listed

Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.

3 other providers at this address

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NPI record

NPI: 1104389006
Entity type: Organization (Type 2)
Issued: Apr 9, 2019
Last updated: Apr 9, 2019
Status: Active
Subpart: Yes of Liberty of Oklahoma Corporation

Other names

Laura Dester Children's Center · doing business as

Authorized official

Hugh M. Sage, PhD
Chief Executive Officer
(580) 213-2782

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1104389006

Liberty of Oklahoma Corporation's National Provider Identifier is 1104389006, issued on Apr 9, 2019. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Tulsa, OK. The record was last updated on Apr 9, 2019.