1104992403 NPI number — SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH OF OKLAHOMA, INC.

Table of content: (NPI 1104992403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104992403 NPI number — SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH OF OKLAHOMA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH OF 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:
SAFY OF OKLAHOMA - OKLAHOMA CITY
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:
1104992403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10100 ELIDA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELPHOS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45833-9056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-695-8010
Provider Business Mailing Address Fax Number:
419-695-0004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N MERIDIAN AVE
Provider Second Line Business Practice Location Address:
SUITE #280-N
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73107-6560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-942-5570
Provider Business Practice Location Address Fax Number:
405-942-5603
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLOOMINGDALE
Authorized Official First Name:
MARC
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
817-789-2611

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100710730E , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100710730A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100710730D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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