NPIMap

Organization Active NPI

Liberty of Oklahoma Corporation

  • Intellectual Disabilities Intermediate Care Facility
  • Tulsa, OK
National Provider Identifier
1104389006
Registry record updated Apr 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
LIBERTY OF OKLAHOMA CORPORATION
Practice address
7318 E Pine St
Tulsa, OK 74115-5743
Phone
(539) 292-4607
NPI assigned
Apr 9, 2019
Organization subpart
Yes
Parent organization
LIBERTY OF OKLAHOMA CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Hugh M. Sage, PHD
Title
Chief Executive Officer
Phone
(580) 213-2782

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

7318 E Pine St
Tulsa, OK 74115-5743

Mailing address

7318 E Pine St
Tulsa, OK 74115-5743
Phone (539) 292-4607

Other identifiers 1

IdentifierTypeStateIssuer
NH7255-7255MedicaidOK

Other names 1

  • Laura Dester Children's Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Liberty of Oklahoma Corporation3 organizations share this tax ID, including this one
Part of
Liberty of Oklahoma Corporation

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7318 E Pine St
Tulsa, OK 74115
Phone (539) 292-4607

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554768000000",
    "number": "1104389006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7318 E PINE ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741155743",
            "telephone_number": "539-292-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7318 E PINE ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741155743",
            "telephone_number": "539-292-4607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY OF OKLAHOMA CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIBERTY OF OKLAHOMA CORPORATION",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A",
        "authorized_official_last_name": "SAGE",
        "authorized_official_first_name": "HUGH",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "580-213-2782",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NH7255-7255",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laura Dester Children's Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.