Provider Demographics
NPI:1124228127
Name:KEETOOWAH - CHEROKEE TREATMENT SERVICES
Entity Type:Organization
Organization Name:KEETOOWAH - CHEROKEE TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-835-3017
Mailing Address - Street 1:2727 E ADMIRAL PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74110-5436
Mailing Address - Country:US
Mailing Address - Phone:918-835-3017
Mailing Address - Fax:918-835-0358
Practice Address - Street 1:2727 E ADMIRAL PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-5436
Practice Address - Country:US
Practice Address - Phone:918-835-3017
Practice Address - Fax:918-835-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKODMHSAS276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit