Provider Demographics
NPI:1245554716
Name:SOLSTICE LIVING SOLUTIONS, INC.
Entity type:Organization
Organization Name:SOLSTICE LIVING SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:DOBROTT
Authorized Official - Last Name:BERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-268-2260
Mailing Address - Street 1:2642 E 21ST ST
Mailing Address - Street 2:SUITE 285
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1716
Mailing Address - Country:US
Mailing Address - Phone:918-574-8800
Mailing Address - Fax:918-574-8801
Practice Address - Street 1:2642 E 21ST ST STE 285
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1789
Practice Address - Country:US
Practice Address - Phone:918-574-8800
Practice Address - Fax:918-574-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA100654OtherMEDICARE PTAN