1477600427 NPI number — YOUTH AND FAMILY SERVICES OF NORTH CENTRAL OKLAHOMA INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477600427 NPI number — YOUTH AND FAMILY SERVICES OF NORTH CENTRAL OKLAHOMA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUTH AND FAMILY SERVICES OF NORTH CENTRAL OKLAHOMA 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:
YOUTH & FAMILY SERVICES OF NCO
Provider Other Organization Name Type Code:
5
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:
1477600427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 W. OXFORD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENID
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73701-1256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-233-7220
Provider Business Mailing Address Fax Number:
580-237-7550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 W. OXFORD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73701-1256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-233-7220
Provider Business Practice Location Address Fax Number:
580-237-7550
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOOKOUT
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
580-233-7220

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: 100731500D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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