Provider Demographics
NPI:1164643409
Name:PARKSIDE, INC.
Entity Type:Organization
Organization Name:PARKSIDE, INC.
Other - Org Name:PARKSIDE PSYCHIATRIC HOSPITAL & CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SACHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-588-8826
Mailing Address - Street 1:1620 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5407
Mailing Address - Country:US
Mailing Address - Phone:918-582-2131
Mailing Address - Fax:
Practice Address - Street 1:1220 S TRENTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5421
Practice Address - Country:US
Practice Address - Phone:918-582-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100738360OMedicaid