Provider Demographics
NPI:1013032424
Name:ADDICTION & BEHAVIORAL HEALTH CENTER, IN.
Entity Type:Organization
Organization Name:ADDICTION & BEHAVIORAL HEALTH CENTER, IN.
Other - Org Name:ADA AREA CHEMICAL DEPENDENCY CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:ORSBURN
Authorized Official - Suffix:
Authorized Official - Credentials:CADC, BA
Authorized Official - Phone:580-332-3001
Mailing Address - Street 1:230 E. 12TH ST.
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820
Mailing Address - Country:US
Mailing Address - Phone:580-332-3001
Mailing Address - Fax:580-332-8774
Practice Address - Street 1:230 E. 12TH ST.
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6508
Practice Address - Country:US
Practice Address - Phone:580-332-3001
Practice Address - Fax:580-332-3652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732530AMedicaid