Provider Demographics
NPI:1649392457
Name:EASTERN OKLAHOMA COUNTY TECHNOLOGY
Entity Type:Organization
Organization Name:EASTERN OKLAHOMA COUNTY TECHNOLOGY
Other - Org Name:EOC SR ADULT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUSOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-390-6603
Mailing Address - Street 1:4601 N CHOCTAW RD
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-9017
Mailing Address - Country:US
Mailing Address - Phone:405-390-9591
Mailing Address - Fax:405-390-6639
Practice Address - Street 1:4601 N CHOCTAW RD
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-9017
Practice Address - Country:US
Practice Address - Phone:405-390-4400
Practice Address - Fax:405-390-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC5505-5505261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100682160BMedicaid