Provider Demographics
NPI:1578690137
Name:COMMUNITY ADOLESCENT REHABILITATIVE EFFORT FOR CHANGE INC
Entity Type:Organization
Organization Name:COMMUNITY ADOLESCENT REHABILITATIVE EFFORT FOR CHANGE INC
Other - Org Name:CARE FOR CHANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CALETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-524-5525
Mailing Address - Street 1:3621 N KELLEY AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-4520
Mailing Address - Country:US
Mailing Address - Phone:405-524-5525
Mailing Address - Fax:405-524-5528
Practice Address - Street 1:3621 N KELLEY AVE
Practice Address - Street 2:STE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-4520
Practice Address - Country:US
Practice Address - Phone:405-524-5525
Practice Address - Fax:405-524-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0804X251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100742980AMedicaid