1881716900 NPI number — CHILDRENS' RECOVERY CENTER OF OKLAHOMA

Table of content: (NPI 1881716900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881716900 NPI number — CHILDRENS' RECOVERY CENTER OF OKLAHOMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDRENS' RECOVERY CENTER OF OKLAHOMA
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:
CHILDRENS RECOVERY CENTER - CBSEC
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:
1881716900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 151
Provider Second Line Business Mailing Address:
ATTN: GMH FINANCE
Provider Business Mailing Address City Name:
NORMAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73070-0151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-573-3811
Provider Business Mailing Address Fax Number:
405-573-3960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 12TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORMAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73071-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-573-3811
Provider Business Practice Location Address Fax Number:
405-573-3960
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAPPS
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
EXECUTIVE DIRECTOR (INTERIM)
Authorized Official Telephone Number:
405-573-3811

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: 100688950B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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