Provider Demographics
NPI:1073766465
Name:ALPHA 2
Entity Type:Organization
Organization Name:ALPHA 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-628-2539
Mailing Address - Street 1:1608 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-1038
Mailing Address - Country:US
Mailing Address - Phone:580-628-2539
Mailing Address - Fax:580-628-4316
Practice Address - Street 1:1608 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653
Practice Address - Country:US
Practice Address - Phone:580-628-2539
Practice Address - Fax:580-628-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility