| Revitalisong Hope Llc | |
|
3321 Iron Mound Road Guthrie OK 73044 | |
| (405) 831-3202 | |
| Not Available |
| Full Name | Revitalisong Hope Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 3321 Iron Mound Road, Guthrie, Oklahoma |
| Authorized Official Name and Position | Bobby H. Long (PRESIDENT) |
| Authorized Official Contact | 4058313202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalisong Hope Llc 2231 Iron Mound Rd Guthrie OK 73044-5778 Ph: (405) 282-6305 | Revitalisong Hope Llc 3321 Iron Mound Road Guthrie OK 73044 Ph: (405) 831-3202 |
| NPI Number | 1790003861 |
|---|---|
| Provider Enumeration Date | 05/13/2010 |
| Last Update Date | 05/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790003861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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