Provider Demographics
NPI:1487823290
Name:CHICKASHA OPPORTUNITY CENTER, INC.
Entity Type:Organization
Organization Name:CHICKASHA OPPORTUNITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-224-4916
Mailing Address - Street 1:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73023-0685
Mailing Address - Country:US
Mailing Address - Phone:405-224-4916
Mailing Address - Fax:405-224-4987
Practice Address - Street 1:1804 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2707
Practice Address - Country:US
Practice Address - Phone:405-224-4916
Practice Address - Fax:405-224-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251C00000X, 320900000X, 347C00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child