Provider Demographics
NPI:1447949425
Name:SECRET OF THE HEART TRANSITIONAL LIVING
Entity type:Organization
Organization Name:SECRET OF THE HEART TRANSITIONAL LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARITTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANDON
Authorized Official - Suffix:
Authorized Official - Credentials:BA-CM II
Authorized Official - Phone:405-676-2868
Mailing Address - Street 1:1619 NE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-2607
Mailing Address - Country:US
Mailing Address - Phone:405-676-2868
Mailing Address - Fax:
Practice Address - Street 1:1619 NE 11TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-2607
Practice Address - Country:US
Practice Address - Phone:405-676-2868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty