Provider Demographics
NPI:1093300980
Name:FRETZPARK HOMES, INC
Entity Type:Organization
Organization Name:FRETZPARK HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-521-8232
Mailing Address - Street 1:4232 N SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-8517
Mailing Address - Country:US
Mailing Address - Phone:405-521-8233
Mailing Address - Fax:405-521-8803
Practice Address - Street 1:4232 N SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-8517
Practice Address - Country:US
Practice Address - Phone:405-521-8232
Practice Address - Fax:405-521-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200110980Medicaid