Provider Demographics
NPI:1477643104
Name:OFFICE OF JUVENILE AFFAIRS, STATE OF OKLAHOMA
Entity Type:Organization
Organization Name:OFFICE OF JUVENILE AFFAIRS, STATE OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-530-2800
Mailing Address - Street 1:PO BOX 268812
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8812
Mailing Address - Country:US
Mailing Address - Phone:405-530-2800
Mailing Address - Fax:405-530-2911
Practice Address - Street 1:3812 N SANTA FE AVE STE 400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-8500
Practice Address - Country:US
Practice Address - Phone:405-530-2800
Practice Address - Fax:405-530-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251B00000XAgenciesCase Management
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100664480AOtherOHCA PROVIDER ID TCM
OK100718320AOtherOHCA PROVIDER ID RBMS