Provider Demographics
NPI:1114266152
Name:CHICKASAW NATION
Entity Type:Organization
Organization Name:CHICKASAW NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR COMMUNITY BASED SERVICES-
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-559-0810
Mailing Address - Street 1:1400 HOPPE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2313
Mailing Address - Country:US
Mailing Address - Phone:580-559-0810
Mailing Address - Fax:580-272-5734
Practice Address - Street 1:101 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-5301
Practice Address - Country:US
Practice Address - Phone:405-331-2300
Practice Address - Fax:405-331-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility