Provider Demographics
NPI:1356463780
Name:NORMAN ALCOHOL & DRUG TREATMENT CENTER
Entity Type:Organization
Organization Name:NORMAN ALCOHOL & DRUG TREATMENT CENTER
Other - Org Name:NADTC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WYNEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-573-8235
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0151
Mailing Address - Country:US
Mailing Address - Phone:405-573-6634
Mailing Address - Fax:405-573-6660
Practice Address - Street 1:900 E MAIN ST
Practice Address - Street 2:BLDG 54
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5305
Practice Address - Country:US
Practice Address - Phone:405-573-6634
Practice Address - Fax:405-573-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEXEMPT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========-108OtherNADTC BCBS PROVIDER ID