Provider Demographics
NPI:1629130166
Name:NORMAN ALCOHOL INFORMATION CENTER
Entity Type:Organization
Organization Name:NORMAN ALCOHOL INFORMATION CENTER
Other - Org Name:THE VIRTUE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLLADO
Authorized Official - Suffix:
Authorized Official - Credentials:MHR
Authorized Official - Phone:405-321-0022
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0730
Mailing Address - Country:US
Mailing Address - Phone:405-321-0022
Mailing Address - Fax:405-360-4918
Practice Address - Street 1:2457 WILCOX DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3956
Practice Address - Country:US
Practice Address - Phone:405-321-0022
Practice Address - Fax:405-321-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100709520AMedicaid
OK1629130166Medicaid