SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC (NPI# 1528383841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528383841 |
| Entity Type | Organization |
| Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC |
| Other Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH |
| Practice Address |
1027 E 66th Pl Tulsa OK 74136-3701 |
| Mailing Address |
6262 S Sheridan Rd Tulsa OK 74133-4055 |
| Practice Telephone | 9184928200 |
| Practice Fax Number | 9184880940 |
| Mailing Telephone | 9184928200 |
| Mailing Fax Number | 9184922849 |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2010-03-30 |
| Authorized Official Name | KEVIN BURGESS (CEO) |
| 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 | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
25487 | OK | Suppliers |
| Other Name | Type Code |
|---|---|
| Shadow Mountain Behavioral Health | 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 |
| 1285867713 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Residential Treatment Facility | 4012 E 35th St, Tulsa, OK 74135-4528 | 2009-09-01 |
| 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 |
1027 E 66TH PL |
| City | TULSA |
| State | OK |
| Zip Code | 74136-3701 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982758538 | Shadow Mountain Behavioral Health Care System, LLC | Psychiatric Residential Treatment Facility | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2007-01-22 |
| 1447555222 | Misty Mcconahy | Social Worker | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2011-01-25 |
| 1407159411 | Amy Lynn Gordon | Physician Assistant | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2010-12-13 |
| 1760708390 | Kathryn Lee Blalock | Social Worker | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2010-04-07 |
| 1013243419 | Grey Mckellar | Counselor | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2009-10-20 |
| 1093953077 | Jeffrey Michael Bremer | Social Worker | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2009-01-28 |
| 1316091457 | Shadow Mountain Behavioral Health System LLC | Psychiatric Residential Treatment Facility | 1027 E 66th Pl, Tulsa, OK 74136-3701 | 2007-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912520883 | Esmeralda Rosales | Behavior Technician | 7306 S. Yale Ave, Tulsa, OK 74136 | 2020-05-26 |
| 1851939631 | Kenneth Aaron Pohl | Behavior Technician | 7107 S. Braden Ave. Suite 195, Tulsa, OK 74136 | 2019-12-12 |
| 1578109195 | Brett Ray Weaver | Chiropractor | Kelly Bldg Ste 106, 6565 S Yale Ave, Tulsa, OK 74136 | 2019-11-19 |
| 1477194488 | Adhd and Mood Center of Oklahoma | Clinic/Center | 6565 South Yale Ave, Suite 706, Tulsa, OK 74136 | 2019-10-01 |
| 1093272510 | Whitney Christine Pilkenton | Registered Nurse | 6161 S. Yale Ave., Tulsa, OK 74136 | 2019-02-21 |
| 1538639190 | Osu Center for Health Sciences | Clinic/Center | 6465 S. Yale Ave. Suite 514, Tulsa, OK 74136 | 2018-11-27 |
| 1043786304 | Saint Francis Hospital, Inc. | Hospice Care, Community Based | 6600 South Yale Ave Suite 350, Tulsa, OK 74136 | 2018-10-15 |
| 1891282877 | Premier Rheumatology of Oklahoma | Internal Medicine | 6114 E. 61st Street, Tulsa, OK 74136 | 2018-04-16 |
| 1679092175 | Grace Eloise Evans | Counselor | 6655 S. Yale Ave, Tulsa, OK 74136 | 2017-09-15 |
| 1598283756 | David Oladipo Abioye | Counselor | 7110 S Utica Avenue, Suite 613, Tulsa, OK 74136 | 2017-09-07 |
| Find all providers in zip 74136 | ||||
| Taxonomy Code | 3336I0012X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Institutional Pharmacy |
| A pharmacy in a hospital (inpatient) or institution used by pharmacists for the compounding and delivery of medicinal preparations to be administered to the patient by nursing or other authorized personnel. Institutional Pharmacies also counsel patients and caregivers; administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235346479 | Tulsa Spine & Specialty Hospital Pharmacy | Pharmacy | 6901 S Olympia Ave, Tulsa, OK 74132 | 2007-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811229966 | Us Dept of Justice | Pharmacy | 4205 E Highway 66, El Reno, OK 73036-9701 | 2010-01-31 |
| 1710174107 | Northwest Center for Behavioral Health | Pharmacy | 1 Mi E Hwy 270, Fort Supply, OK 73841-0001 | 2007-09-28 |
| 1992134852 | Mercy Hospital Ada Pharmacy | Pharmacy | 430 N Monte Vista St, Ada, OK 74820-4610 | 2013-11-01 |
| 1558582387 | Moore Medical Center | Pharmacy | 700 S Telephone Rd, Moore, OK 73160-2502 | 2007-05-01 |
| 1518028380 | Jackson County Memorial Hosp Phcy | Pharmacy | 1200 E Pecan St, Altus, OK 73521-6141 | 2006-12-13 |
| 1437226917 | Owasso Medical Facility LLC | Pharmacy | 12451 E 100th St N, Owasso, OK 74055-4600 | 2006-11-29 |
| 1285727446 | State of Oklahoma Office of State Finance | Pharmacy | 1101 E Monroe Ave, Mcalester, OK 74501-4815 | 2006-10-02 |
| 1285739045 | Norman Regional Hospital | Pharmacy | 901 N Porter, Norman, OK 73071-6404 | 2006-09-14 |
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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.