Provider Demographics
NPI:1740600436
Name:COMMUNITY ACCESS, INCORPORATED
Entity Type:Organization
Organization Name:COMMUNITY ACCESS, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-353-2045
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-0154
Mailing Address - Country:US
Mailing Address - Phone:580-353-2045
Mailing Address - Fax:580-353-6470
Practice Address - Street 1:1104 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-8458
Practice Address - Country:US
Practice Address - Phone:580-353-2045
Practice Address - Fax:580-353-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100634430Medicaid