Provider Demographics
NPI:1023398062
Name:YOUTHCARE OF OKLAHOMA
Entity Type:Organization
Organization Name:YOUTHCARE OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSRS
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:580-225-4133
Mailing Address - Street 1:11297 N 1976 RD
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-6002
Mailing Address - Country:US
Mailing Address - Phone:580-225-4133
Mailing Address - Fax:
Practice Address - Street 1:11297 N 1976 RD
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-6002
Practice Address - Country:US
Practice Address - Phone:580-225-4133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization