1265751325 NPI number — CENTER FOR POSITIVE CHANGE, 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 1265751325 NPI number — CENTER FOR POSITIVE CHANGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR POSITIVE CHANGE, 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:
1265751325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 S 5TH ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUKON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73099-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-256-5996
Provider Business Mailing Address Fax Number:
405-265-2553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1607 PROFESSIONAL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUKON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73099-6314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-265-2800
Provider Business Practice Location Address Fax Number:
405-265-2553
Provider Enumeration Date:
05/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
KAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
405-256-5996

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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