1457397325 NPI number — CRANE YOUNG AND ASSOCIATES INC

Table of content: (NPI 1457397325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457397325 NPI number — CRANE YOUNG AND ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRANE YOUNG AND ASSOCIATES 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:
HERITAGE MANOR
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:
1457397325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3714 N PORTLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73112-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-942-3884
Provider Business Mailing Address Fax Number:
405-946-2642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3804 N BARR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73122-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-789-7945
Provider Business Practice Location Address Fax Number:
405-787-4061
Provider Enumeration Date:
06/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRANE
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
405-942-3884

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  NH5522-5522 , 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)

  • Identifier: 200055480A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".