Provider Demographics
NPI:1679806392
Name:MCCALL'S CHAPEL SCHOOL INC
Entity Type:Organization
Organization Name:MCCALL'S CHAPEL SCHOOL INC
Other - Org Name:MCCALL'S CHAPEL SCHOOL INC - COTTAGE 15
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HONEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-272-6615
Mailing Address - Street 1:13546 COUNTY ROAD 3600
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5378
Mailing Address - Country:US
Mailing Address - Phone:580-272-6600
Mailing Address - Fax:580-272-6665
Practice Address - Street 1:13546 COUNTY ROAD 3600
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5378
Practice Address - Country:US
Practice Address - Phone:580-272-6600
Practice Address - Fax:580-272-6665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH6220-6220310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100773130YMedicaid