Provider Demographics
NPI:1033364435
Name:SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH OF OKLAHOMA, INC.
Entity Type:Organization
Organization Name:SPECIALIZED ALTERNATIVES FOR FAMILIES AND YOUTH OF OKLAHOMA, INC.
Other - Org Name:SAFY OF ALTUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STATE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCPA, LCCA
Authorized Official - Phone:817-789-2611
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-695-0004
Practice Address - Street 1:220 N LEE ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3818
Practice Address - Country:US
Practice Address - Phone:580-355-8883
Practice Address - Fax:580-355-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100710730GMedicaid