| Pennington Creek Life House | |
|
801 E Main St Tishomingo OK 73460-2351 | |
| (580) 371-3776 | |
| Not Available |
| Full Name | Pennington Creek Life House |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 801 E Main St, Tishomingo, Oklahoma |
| Authorized Official Name and Position | Jan Owens (OWNER) |
| Authorized Official Contact | 5803713776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pennington Creek Life House 801 East Main Street Tishomingo OK 73460 Ph: () - | Pennington Creek Life House 801 E Main St Tishomingo OK 73460-2351 Ph: (580) 371-3776 |
| NPI Number | 1164771366 |
|---|---|
| Provider Enumeration Date | 09/04/2012 |
| Last Update Date | 09/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164771366 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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