Provider Demographics
NPI:1083848592
Name:ROSE ROCK RECOVERY CENTER
Entity Type:Organization
Organization Name:ROSE ROCK RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC/LADC
Authorized Official - Phone:918-256-9124
Mailing Address - Street 1:24919 S 4420 RD
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-5529
Mailing Address - Country:US
Mailing Address - Phone:918-256-9210
Mailing Address - Fax:
Practice Address - Street 1:24919 S 4420 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-5529
Practice Address - Country:US
Practice Address - Phone:918-256-9210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK682324500000X
OK1867324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1867OtherLICENSED PROFESSIONAL COUNSELOR
OK682OtherLICENSED ALCOHOL AND DRUG COUNSELOR