SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC (NPI# 1982005971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982005971 |
| Entity Type | Organization |
| Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC |
| Other Organization Name | SHADOW MOUNTAIN BEHAVIORAL HEALTH |
| Practice Address |
6262 S Sheridan Rd Tulsa OK 74133-4055 |
| Mailing Address |
6262 S Sheridan Road Tulsa OK 74133-4055 |
| Practice Telephone | 9184928200 |
| Practice Fax Number | 9184933268 |
| Mailing Telephone | 9184928200 |
| Mailing Fax Number | 9184933268 |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2014-09-09 |
| Authorized Official Name | MIKE KISTLER (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 9184928200 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 283Q00000X | Psychiatric Hospital | Hospitals |
| 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 |
| 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 |
| 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 |
6262 S SHERIDAN RD |
| City | TULSA |
| State | OK |
| Zip Code | 74133-4055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164483574 | Linda K Morgan | Counselor | 6262 S Sheridan Rd, Shadow Mountain Behavioral Health, Tulsa, OK 74133 | 2006-03-28 |
| 1225699366 | Lilli Kay Higgins | Recreation Therapist | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2019-06-27 |
| 1578076881 | Diamond Walker | Case Manager/Care Coordinator | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2017-11-08 |
| 1689119687 | Carolyn Becker | Counselor | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2016-12-29 |
| 1134573090 | Regina M Mellen Pllc | Nurse Anesthetist, Certified Registered | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2016-04-18 |
| 1366820839 | Derrick Woodbury | Counselor | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2015-05-15 |
| 1669876108 | Jennifer Mckissick Do Inc PC | Anesthesiology | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2014-10-13 |
| 1902224801 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Hospital | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2014-03-29 |
| 1710296272 | Shadow Mountain Behavioral Health | Psychiatric Hospital | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2010-10-01 |
| 1114231701 | Janice Hicks-ulrich | Counselor | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2010-08-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932725058 | Economy Pharmacy | Pharmacy | 10120 E 91st, Tulsa, OK 74133 | 2020-06-24 |
| 1710539424 | Fresenius Medical Care Tulsa, LLC | Clinic/Center | 9310 East 91st Street, Tulsa, OK 74133 | 2019-07-12 |
| 1003382060 | Carefirst Pharmacy Tulsa, Inc. | Pharmacy | 6214 S. Sheridan Rd, Tulsa, OK 74133 | 2018-10-17 |
| 1003397332 | Adekemi Taiwo | Nurse Practitioner | Hillcrest South Medical Plaza, 8803 S. 101 St E. Ave. Suite 350, Tulsa, OK 74133 | 2018-08-24 |
| 1346732013 | Lauren Nichols | Dentist | 7707 E 111th St Ste 105, Tulsa, OK 74133 | 2018-05-30 |
| 1699264259 | Courtney N Johnson, Pllc | Dentist | 7901 S Sheridan Rd Unit A, Tulsa, OK 74133 | 2018-05-08 |
| 1417464199 | Tulsa Medical and Orthopedic Center PC | Family Medicine | 8165 S Mingo Rd Ste 200, Tulsa, OK 74133 | 2018-01-04 |
| 1013421023 | Susan C. Willard, Do, Pllc | Family Medicine | 6532 E. 71st Street, Suite 150, Tulsa, OK 74133 | 2017-11-29 |
| 1851800825 | Seyva LLC | Clinic/Center | 8522 S 70th E Ave, Tulsa, OK 74133 | 2017-09-21 |
| 1477072031 | Amanda Dawn Long | Registered Nurse | 10507 E 91st St Ste 310, Tulsa, OK 74133 | 2017-09-14 |
| Find all providers in zip 74133 | ||||
| Taxonomy Code | 283Q00000X |
| Grouping | Hospitals |
| Classification | Psychiatric Hospital |
| An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. |
| Notes: Source: Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104224856 | Erica Gregory | Psychiatric Hospital | 211 S Garnett Rd, Tulsa, OK 74128-1805 | 2014-12-11 |
| 1437370772 | Parkside, Inc. | Psychiatric Hospital | 1619 East 13th Street, Tulsa, OK 74120-5410 | 2007-05-02 |
| 1902224801 | Shadow Mountain Behavioral Health System, LLC | Psychiatric Hospital | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2014-03-29 |
| 1750714721 | Parkside, Inc. | Psychiatric Hospital | 1619 E 13th St, Tulsa, OK 74120-5410 | 2013-08-14 |
| 1174866875 | Parkside Psychiatric Hospital & Clinic | Psychiatric Hospital | 1619 E 13th St, 1620 E. 12th, Tulsa, OK 74120-5410 | 2013-04-01 |
| 1326396391 | Parkside, Inc. | Psychiatric Hospital | 1220 S Trenton Ave, Tulsa, OK 74120-5421 | 2012-08-24 |
| 1710296272 | Shadow Mountain Behavioral Health | Psychiatric Hospital | 6262 S Sheridan Rd, Tulsa, OK 74133-4055 | 2010-10-01 |
| 1891988424 | John B White, Md PC | Psychiatric Hospital | 1620 E 12th St, Tulsa, OK 74120-5407 | 2007-08-27 |
| 1083807366 | Oklahoma Medical and Psychiatric Services Inc | Psychiatric Hospital | 2913 E 88th St, Tulsa, OK 74137-2508 | 2007-08-21 |
| 1174660518 | Brookhaven Hospital Inc. | Psychiatric Hospital | 201 S Garnett Rd, Tulsa, OK 74128-1805 | 2007-02-01 |
| 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.