1104071257 NPI number — THERAPEUTIC CARE DIMENSIONS INC

Table of content: (NPI 1104071257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104071257 NPI number — THERAPEUTIC CARE DIMENSIONS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPEUTIC CARE DIMENSIONS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104071257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 W GRAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73069-7117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-809-4200
Provider Business Mailing Address Fax Number:
405-364-5379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12101 N MACARTHUR BLVD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73162-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-650-7577
Provider Business Practice Location Address Fax Number:
405-470-7428
Provider Enumeration Date:
11/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
HELEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-650-7577

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R0029205 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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