OrganizationActive
Integrated Renegade, LLC
NPI 1366223265 · Community/Behavioral Health Agency · Glenpool, OK
Provider details
- NPI number
- 1366223265
- Entity type
- Organization
- Primary specialty
- Community/Behavioral Health AgencyAgencies
- Organization subpart
- No
- Authorized official
- Petra Russell, Owner(918) 321-0697
Specialties & taxonomies
Agencies
Profile Score
Established profile(57/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
2 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1264 E 139th Pl
Glenpool, OK 74033-3125
Phone: (918) 321-0697
Street-level locationGet directions
Mailing address
1264 E 139th Pl
Glenpool, OK 74033-3125
Registry dates
- Enumerated
- 2023-10-09
- Last updated
- 2023-10-09
- Certified
- 2023-10-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.