1154652915 NPI number — ROCMND AREA YOUTH SERVICES INC

Table of content: (NPI 1154652915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154652915 NPI number — ROCMND AREA YOUTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCMND AREA YOUTH SERVICES 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:
1154652915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 N MAIN ST STE 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74354-3359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-540-1563
Provider Business Mailing Address Fax Number:
918-542-7778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 N MAIN ST STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74354-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-540-1563
Provider Business Practice Location Address Fax Number:
918-542-7778
Provider Enumeration Date:
01/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NEAL
Authorized Official First Name:
DEE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASST. DIRECTOR
Authorized Official Telephone Number:
918-256-7515

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: 100732380C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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