Provider Demographics
NPI:1679890776
Name:RESTORATION YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:RESTORATION YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:POULTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-354-6010
Mailing Address - Street 1:300 S RANCHWOOD BLVD
Mailing Address - Street 2:SUITE 15-16
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2741
Mailing Address - Country:US
Mailing Address - Phone:405-354-6010
Mailing Address - Fax:405-354-6070
Practice Address - Street 1:300 S RANCHWOOD BLVD
Practice Address - Street 2:SUITE 15-16
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2741
Practice Address - Country:US
Practice Address - Phone:405-354-6010
Practice Address - Fax:405-354-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK999720928251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health