1386870293 NPI number — KI BOIS COMMUNITY ACTION FOUNDATION

Table of content: (NPI 1386870293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386870293 NPI number — KI BOIS COMMUNITY ACTION FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KI BOIS COMMUNITY ACTION FOUNDATION
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:
THE OAKS REHABILITATIVE SERVICES CENTER
Provider Other Organization Name Type Code:
3
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:
1386870293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 727
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STIGLER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74462-0727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-967-3325
Provider Business Mailing Address Fax Number:
918-967-8660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBURTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74578-4047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-465-3381
Provider Business Practice Location Address Fax Number:
918-465-3053
Provider Enumeration Date:
06/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HUGGINS
Authorized Official First Name:
R.
Authorized Official Middle Name:
CARROLL
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/CEO
Authorized Official Telephone Number:
918-967-3325

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100680370O , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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