Provider Demographics
NPI:1598854598
Name:SOUTHWEST OKLAHOMA COMMUNITY ACTION GROUP, INC.
Entity Type:Organization
Organization Name:SOUTHWEST OKLAHOMA COMMUNITY ACTION GROUP, INC.
Other - Org Name:SW ADULT DAYCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:CCAP
Authorized Official - Phone:580-482-5040
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-1088
Mailing Address - Country:US
Mailing Address - Phone:580-482-5040
Mailing Address - Fax:580-482-5433
Practice Address - Street 1:2208 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5843
Practice Address - Country:US
Practice Address - Phone:580-477-0701
Practice Address - Fax:580-477-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC3301-3301261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care