SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC (NPI# 1285867713) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285867713 |
| Entity Type | Organization |
| Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC |
| Other Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM |
| Practice Address |
4012 E 35th St Tulsa OK 74135-4528 |
| Mailing Address |
6262 S Sheridan Rd Tulsa OK 74133-4055 |
| Practice Telephone | 9184928200 |
| Practice Fax Number | 9184933268 |
| Mailing Telephone | 9184928200 |
| Mailing Fax Number | 9184933268 |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2009-09-01 |
| Authorized Official Name | MIKE KISTLER (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9184928200 |
| Is Organization Subpart | Y |
| Parent Organization Name | PSYCHIATRIC SOLUTIONS INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 323P00000X | Psychiatric Residential Treatment Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Shadow Mountain Behavioral Health System | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316056534 | Shadow Mountain Behavioral Health System, LLC | Clinic/Center | 5350 S Western Ave, Suite 555`, Oklahoma City, OK 73109-4520 | 2006-08-30 |
| 1841304250 | Shadow Mountain Behavioral Health System, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 2801 Venture Dr, Norman, OK 73069-8215 | 2006-08-19 |
| 1982005971 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Hospital | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2014-09-09 |
| 1902224801 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Hospital | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2014-03-29 |
| 1184941148 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2010-04-29 |
| 1528383841 | Shadow Mountain Behavioral Health System, LLC | Pharmacy | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2010-03-30 |
| 1831304351 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2007-05-10 |
| 1740384049 | Shadow Mountain Behavioral Health System, LLC | Clinic/Center | 6125 S Sheridan Rd, Suite D, Tulsa, OK 74133-4056 | 2006-09-08 |
| 1659475952 | Shadow Mountain Behavioral Health System, LLC | Clinic/Center | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2006-09-08 |
| 1003923442 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2006-08-23 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC | 367 S. Gulph Road, King of Prussia, PA 19406 |
| Street Address |
4012 E 35TH ST |
| City | TULSA |
| State | OK |
| Zip Code | 74135-4528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457356560 | Tulsa County Juvenile Justice Trust Authority | Community Based Residential Treatment Facility, Mental Illness | 4012 E 35th St, Tulsa, OK 74135-4528 | 2005-06-15 |
| 1225030695 | Volunteers of America Inc., Crewson Youth Centers | Community Based Residential Treatment Facility, Mental Illness | 4012 E 35th St, Tulsa, OK 74135-4528 | 2005-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761590 | Dr. Whitney M. Ellsworth, Dpt, Pllc | Physical Therapist | 4185 S Harvard Ave, Suite E-1, Tulsa, OK 74135 | 2020-08-20 |
| 1942839089 | Kimberly Renee Gillens | Student in an Organized Health Care Education/Training Program | 4502 E 41st Street Obgyn Department, Tulsa, OK 74135 | 2020-04-01 |
| 1528525524 | Everest Pain Management | Clinic/Center | 4134 S Harvard Ave Suite B1, Tulsa, OK 74135 | 2019-02-26 |
| 1326524216 | Shelley Deeann Anderson | Technician | 7359 S 68th, Tulsa, OK 74135 | 2018-07-14 |
| 1811489065 | Taylor Diane Spears | Behavioral Analyst | 4835 S Fulton Ave Suite 104, Tulsa, OK 74135 | 2018-06-04 |
| 1225547821 | Heather Nicole Freed | Counselor | 4363 S Harvard Ave, Tulsa, OK 74135 | 2017-09-26 |
| 1306363924 | Danielle Walker | Case Manager/Care Coordinator | 3244 S Lakewood Ave Apt 4e, Tulsa, OK 74135 | 2017-08-24 |
| 1346766078 | Angels Place | Day Training, Developmentally Disabled Services | 3919 S. Oswego Avenue, Tulsa, OK 74135 | 2017-08-15 |
| 1659800019 | Welena-phay Kamamma Boren | Counselor | 4636 S Harvard Avenue, Tulsa, OK 74135 | 2017-06-08 |
| 1346774197 | Brandie Herren | Registered Nurse | 6333 E Skelly Drive, Tulsa, OK 74135 | 2017-04-19 |
| Find all providers in zip 74135 | ||||
| Taxonomy Code | 323P00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Psychiatric Residential Treatment Facility |
| A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient’s surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary |
| Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144527227 | Riverside Behavioral Health | Psychiatric Residential Treatment Facility | 4618 S 31st West Ave, Tulsa, OK 74107-7532 | 2011-02-25 |
| 1346461688 | Parkside, Inc. | Psychiatric Residential Treatment Facility | 1619 E 13th St, Tulsa, OK 74120-5410 | 2007-05-02 |
| 1164643409 | Parkside, Inc. | Psychiatric Residential Treatment Facility | 1220 S Trenton Ave, Tulsa, OK 74120-5421 | 2007-05-02 |
| 1982758538 | Shadow Mountain Behavioral Health Care System, LLC | Psychiatric Residential Treatment Facility | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2007-01-22 |
| 1184941148 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2010-04-29 |
| 1619130663 | Ahs Hillcrest Medical Center LLC | Psychiatric Residential Treatment Facility | 744 W 9th St, Tulsa, OK 74127-9020 | 2008-07-09 |
| 1831304351 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2007-05-10 |
| 1235268400 | Volunteers of America of Oklahoma, Inc. | Psychiatric Residential Treatment Facility | 9605 E 61st St, Tulsa, OK 74133-6308 | 2007-03-05 |
| 1316091457 | Shadow Mountain Behavioral Health System LLC | Psychiatric Residential Treatment Facility | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2007-01-23 |
| 1164592283 | Ahs Tulsa Regional Medical Center LLC | Psychiatric Residential Treatment Facility | 744 W 9th St, Tulsa, OK 74127-9020 | 2006-11-08 |
| Find all providers in TULSA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.