Provider Demographics
NPI:1003949439
Name:COMMUNITY CHILDREN'S SHELTER & FAMILY SERVICE CENTER
Entity Type:Organization
Organization Name:COMMUNITY CHILDREN'S SHELTER & FAMILY SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-226-1838
Mailing Address - Street 1:15 MONROE ST NE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2025
Mailing Address - Country:US
Mailing Address - Phone:580-226-1838
Mailing Address - Fax:580-223-7856
Practice Address - Street 1:15 MONROE ST NE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2025
Practice Address - Country:US
Practice Address - Phone:580-226-1838
Practice Address - Fax:580-223-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health