Provider Demographics
NPI:1720217946
Name:STATE OF OKLAHOMA DEPARTMENT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:STATE OF OKLAHOMA DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAMS MANGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-521-3565
Mailing Address - Street 1:PO BOX 25352
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-0352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:405-521-4158
Practice Address - Street 1:2400 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-4601
Practice Address - Country:US
Practice Address - Phone:405-521-3565
Practice Address - Fax:405-521-4158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management