Provider Demographics
NPI:1497026173
Name:DEBERRY INTERPRISE
Entity Type:Organization
Organization Name:DEBERRY INTERPRISE
Other - Org Name:NOAH ARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR DEGREE
Authorized Official - Phone:405-259-8400
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-0102
Mailing Address - Country:US
Mailing Address - Phone:405-549-9061
Mailing Address - Fax:
Practice Address - Street 1:9233 NORTH EAST10TH STREET
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130
Practice Address - Country:US
Practice Address - Phone:405-549-9061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health