Provider Demographics
NPI:1073103701
Name:LIFEGATE FREEDOM RECOVERY MINISTRIES, INC.
Entity Type:Organization
Organization Name:LIFEGATE FREEDOM RECOVERY MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-639-4684
Mailing Address - Street 1:11680 S 153RD WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-8564
Mailing Address - Country:US
Mailing Address - Phone:918-639-4684
Mailing Address - Fax:918-512-6320
Practice Address - Street 1:11680 S 153RD WEST AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-8564
Practice Address - Country:US
Practice Address - Phone:918-639-4684
Practice Address - Fax:918-512-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility