Provider Demographics
NPI:1639294044
Name:TRI-CITY SUBSTANCE ABUSE CENTER, INC.
Entity Type:Organization
Organization Name:TRI-CITY SUBSTANCE ABUSE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:I
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-382-1112
Mailing Address - Street 1:214 E OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-3442
Mailing Address - Country:US
Mailing Address - Phone:405-382-1112
Mailing Address - Fax:405-382-5747
Practice Address - Street 1:214 E OAK AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-3442
Practice Address - Country:US
Practice Address - Phone:405-382-1112
Practice Address - Fax:405-382-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty