Provider Demographics
NPI:1245401413
Name:TRI-CITY SUBSTANCE ABUSE CENTER, INC.
Entity Type:Organization
Organization Name:TRI-CITY SUBSTANCE ABUSE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:I
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:CADC, CCS
Authorized Official - Phone:580-332-8773
Mailing Address - Street 1:124 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5807
Mailing Address - Country:US
Mailing Address - Phone:580-332-8773
Mailing Address - Fax:580-332-8774
Practice Address - Street 1:124 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5807
Practice Address - Country:US
Practice Address - Phone:580-332-8773
Practice Address - Fax:580-332-8774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility