Basic Information
| Provider Information | |||||||||
| NPI: | 1235295130 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEOPLE INC. OF SEQUOYAH CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 J T STITES BLVD | ||||||||
| Address2: | |||||||||
| City: | SALLISAW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749559301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187757787 | ||||||||
| FaxNumber: | 9187754382 | ||||||||
| Practice Location | |||||||||
| Address1: | 1606 E DOWNING ST | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744642513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187757787 | ||||||||
| FaxNumber: | 9187754382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | JIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9187757787 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.