Provider Demographics
NPI:1659692010
Name:12&12 INC
Entity Type:Organization
Organization Name:12&12 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASEMANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WAYNETTA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:BRAWDY
Authorized Official - Suffix:
Authorized Official - Credentials:CM
Authorized Official - Phone:918-664-4224
Mailing Address - Street 1:6333 E SKELLY DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6106
Mailing Address - Country:US
Mailing Address - Phone:918-664-4224
Mailing Address - Fax:918-663-0203
Practice Address - Street 1:6333 E SKELLY DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6106
Practice Address - Country:US
Practice Address - Phone:918-664-4224
Practice Address - Fax:918-663-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility