Provider Demographics
NPI:1659503035
Name:RED ROCK WEST
Entity Type:Organization
Organization Name:RED ROCK WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRISIS UNIT COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSNOE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:580-323-6021
Mailing Address - Street 1:90 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-9116
Mailing Address - Country:US
Mailing Address - Phone:580-323-6021
Mailing Address - Fax:580-331-2009
Practice Address - Street 1:90 N 31ST ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-9116
Practice Address - Country:US
Practice Address - Phone:580-323-6021
Practice Address - Fax:580-331-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health