Provider Demographics
NPI:1093145914
Name:KI BOIS COMMUNITY ACTION FOUNDATION
Entity Type:Organization
Organization Name:KI BOIS COMMUNITY ACTION FOUNDATION
Other - Org Name:THE OAKS REHABILITATIVE SERVICES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-967-3325
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-1404
Mailing Address - Country:US
Mailing Address - Phone:918-421-3500
Mailing Address - Fax:918-423-2370
Practice Address - Street 1:628 E CREEK AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-6930
Practice Address - Country:US
Practice Address - Phone:918-421-3500
Practice Address - Fax:918-423-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK01-1372703101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100680370UMedicaid