Provider Demographics
NPI:1629359880
Name:PALMER CONTINUUM OF CARE
Entity Type:Organization
Organization Name:PALMER CONTINUUM OF CARE
Other - Org Name:PALMER DRUG ABUSE PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-832-7763
Mailing Address - Street 1:5319 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6500
Mailing Address - Country:US
Mailing Address - Phone:918-832-7763
Mailing Address - Fax:918-292-8250
Practice Address - Street 1:5319 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6500
Practice Address - Country:US
Practice Address - Phone:918-832-7763
Practice Address - Fax:918-292-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100735150 CMedicaid
OK100735150 BMedicaid
OK100735150 AMedicaid