Pennington Creek Life House
NPI #1164771366 in Tishomingo, Oklahoma
Provider Information
- NPI Number
- 1164771366
- Entity Type
- Organization
- Organization Name
- Pennington Creek Life House
- Primary Specialty
- Community/Behavioral Health
- Enumeration Date
- Sep 4, 2012
- Last Updated
- Sep 4, 2012
Practice Location
- Address
- 801 E MAIN ST
- City
- Tishomingo
- State
- Oklahoma
- ZIP Code
- 73460-2351
- Phone
- (580) 371-3776
Authorized Official
- Name
- JAN OWENS
- Title
- OWNER
- Phone
- (580) 371-3776
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community/Behavioral Health |
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