Provider Demographics
NPI:1245549567
Name:PS&A CASE MANAGEMENT & PROVIDER AGENCY
Entity type:Organization
Organization Name:PS&A CASE MANAGEMENT & PROVIDER AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MHR / MRC
Authorized Official - Phone:918-282-5363
Mailing Address - Street 1:4528 S SHERIDAN RD STE 113
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1140
Mailing Address - Country:US
Mailing Address - Phone:918-282-5363
Mailing Address - Fax:918-585-7152
Practice Address - Street 1:4528 S SHERIDAN RD STE 113
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1101
Practice Address - Country:US
Practice Address - Phone:918-282-5363
Practice Address - Fax:918-585-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200242130AOtherAPS/SOONER CARE
OK200242130AOtherOKLAHOMA HEALTH CARE AUTHORITY (OHCA)
OK200242130AMedicaid
OK200242130AOtherOKLAHOMA HEALTH CARE AUTHORITY (OHCA)