Provider Demographics
NPI:1003860941
Name:SOTTO INTERNATIONAL, INC.
Entity Type:Organization
Organization Name:SOTTO INTERNATIONAL, INC.
Other - Org Name:SERENITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-894-3487
Mailing Address - Street 1:5314 SOUTH YALE AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6271
Mailing Address - Country:US
Mailing Address - Phone:918-770-4441
Mailing Address - Fax:918-712-9880
Practice Address - Street 1:1316 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3826
Practice Address - Country:US
Practice Address - Phone:866-367-9445
Practice Address - Fax:918-712-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4247251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158725747Medicaid
041573Medicare Oscar/Certification