Provider Demographics
NPI:1114351541
Name:SANTA FE RESIDENTIAL CARE HOME
Entity Type:Organization
Organization Name:SANTA FE RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-244-9876
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0148
Mailing Address - Country:US
Mailing Address - Phone:918-244-9876
Mailing Address - Fax:
Practice Address - Street 1:618 E CANADIAN AVE
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-3810
Practice Address - Country:US
Practice Address - Phone:918-244-9876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)