Provider Demographics
NPI:1013017714
Name:PRESTON PUBLIC SCHOOL
Entity Type:Organization
Organization Name:PRESTON PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-3388
Mailing Address - Street 1:10165 PRINGEY AVE
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:OK
Mailing Address - Zip Code:74456
Mailing Address - Country:US
Mailing Address - Phone:918-756-3388
Mailing Address - Fax:918-756-2122
Practice Address - Street 1:10165 PRINGEY AVE
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:OK
Practice Address - Zip Code:74456
Practice Address - Country:US
Practice Address - Phone:918-756-3388
Practice Address - Fax:918-756-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care