NPIMap

Organization Active NPI

South Peoria Neighborhood Connection Foundation

  • Community/Behavioral Health Agency
  • Tulsa, OK
National Provider Identifier
1649549338
Registry record updated Dec 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
296 Issued in OK
Legal business name
SOUTH PEORIA NEIGHBORHOOD CONNECTION FOUNDATION
Practice address
1208 E 58TH St
Tulsa, OK 74105-8401
Phone
(918) 742-5597
Fax
(918) 742-4485
NPI assigned
Dec 25, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 25, 2011

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

Authorized official

Name
Dr. Lanny R Endicott, LCSW, LMFTNPI 1386920585
Title
President
Phone
(918) 830-1523

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 296 OK Primary
Community/Behavioral Health Agency 251S00000X 328 OK

Addresses

Primary practice location

1208 E 58TH St
Tulsa, OK 74105-8401

Mailing address

1208 E 58TH St
Tulsa, OK 74105-8401
Phone (918) 742-5597

Other identifiers 2

IdentifierTypeStateIssuer
1508994138MedicaidOK
100723970BMedicaidOK

Other names 1

  • South Tulsa Community House Doing business as

National Provider Directory

National Provider Directory

Locations

1208 E 58th St
Tulsa, OK 74105
Phone (918) 742-5597

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": "1324771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324771200000",
    "number": "1649549338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 E 58TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741058401",
            "telephone_number": "918-742-5597",
            "fax_number": "918-742-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 E 58TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741058401",
            "telephone_number": "918-742-5597",
            "fax_number": "918-742-4485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PEORIA NEIGHBORHOOD CONNECTION FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-25",
        "last_updated": "2011-12-25",
        "status": "A",
        "authorized_official_last_name": "ENDICOTT",
        "authorized_official_first_name": "LANNY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-830-1523",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LCSW, LMFT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OK",
            "license": "296",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OK",
            "license": "328",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508994138",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100723970B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Tulsa Community House",
            "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 Dec 25, 2011; 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.