Provider Demographics
NPI:1558570309
Name:MEADOW BROOK RESIDENTIAL CARE FACILITY
Entity Type:Organization
Organization Name:MEADOW BROOK RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:D
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-658-2509
Mailing Address - Street 1:1000 MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:OK
Mailing Address - Zip Code:74940
Mailing Address - Country:US
Mailing Address - Phone:918-658-2509
Mailing Address - Fax:918-658-2180
Practice Address - Street 1:1000 MEADOW LANE
Practice Address - Street 2:
Practice Address - City:HOWE
Practice Address - State:OK
Practice Address - Zip Code:74940
Practice Address - Country:US
Practice Address - Phone:918-658-2509
Practice Address - Fax:918-658-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness