Provider Demographics
NPI:1306013008
Name:SPECIAL YOUNG ADULTS, INC.
Entity Type:Organization
Organization Name:SPECIAL YOUNG ADULTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-222-1023
Mailing Address - Street 1:826 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-4423
Mailing Address - Country:US
Mailing Address - Phone:405-222-1023
Mailing Address - Fax:405-222-0284
Practice Address - Street 1:826 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-4423
Practice Address - Country:US
Practice Address - Phone:405-222-1023
Practice Address - Fax:405-222-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100683300OtherOKLAHOMA HEALTH CARE AUTHORITY