Provider Demographics
NPI:1063496065
Name:CENTRAL STATE COMMUNITY SERVICES OKLAHOMA
Entity Type:Organization
Organization Name:CENTRAL STATE COMMUNITY SERVICES OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-664-6944
Mailing Address - Street 1:3840 S 103RD EAST AVE
Mailing Address - Street 2:225
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2438
Mailing Address - Country:US
Mailing Address - Phone:918-664-6944
Mailing Address - Fax:918-664-1706
Practice Address - Street 1:3840 S 103RD EAST AVE
Practice Address - Street 2:225
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2438
Practice Address - Country:US
Practice Address - Phone:918-664-6944
Practice Address - Fax:918-664-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services