Provider Demographics
NPI:1578771879
Name:INDIAN TERRITORY HEALTH SERVICES
Entity Type:Organization
Organization Name:INDIAN TERRITORY HEALTH SERVICES
Other - Org Name:INDIAN TERRITORY ADULT DAYS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-371-2468
Mailing Address - Street 1:105 N NESHOBA ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-1739
Mailing Address - Country:US
Mailing Address - Phone:580-371-2468
Mailing Address - Fax:
Practice Address - Street 1:105 N NESHOBA ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-1739
Practice Address - Country:US
Practice Address - Phone:580-371-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC3501-3501311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility