Provider Demographics
NPI:1770168627
Name:TIAPS REHAB CENTER LLC
Entity type:Organization
Organization Name:TIAPS REHAB CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF SELECTIS MANAGEMENT, LLC
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-449-2100
Mailing Address - Street 1:1530 NE GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-5212
Mailing Address - Country:US
Mailing Address - Phone:405-681-1155
Mailing Address - Fax:405-768-1156
Practice Address - Street 1:1530 NE GRAND BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-5212
Practice Address - Country:US
Practice Address - Phone:405-681-1155
Practice Address - Fax:405-768-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility