Provider Demographics
NPI:1437365137
Name:PREMIER COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PREMIER COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WHYBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-625-6377
Mailing Address - Street 1:4530 S SHERIDAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1141
Mailing Address - Country:US
Mailing Address - Phone:918-627-2668
Mailing Address - Fax:
Practice Address - Street 1:4530 S SHERIDAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1141
Practice Address - Country:US
Practice Address - Phone:918-627-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services