Provider Demographics
NPI:1376933796
Name:MBH OF OKLAHOMA, LLC
Entity Type:Organization
Organization Name:MBH OF OKLAHOMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-434-1828
Mailing Address - Street 1:19821 NW 2ND AVE STE 396
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-3341
Mailing Address - Country:US
Mailing Address - Phone:855-847-7647
Mailing Address - Fax:
Practice Address - Street 1:3400 DESKIN DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-8295
Practice Address - Country:US
Practice Address - Phone:405-701-8530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MBHS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility