Provider Demographics
NPI:1770674756
Name:CHILDRENS' RECOVERY CENTER OF OKLAHOMA
Entity Type:Organization
Organization Name:CHILDRENS' RECOVERY CENTER OF OKLAHOMA
Other - Org Name:OKLAHOMA YOUTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:O
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC CM
Authorized Official - Phone:405-573-3811
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:ATTN: GMH FINANCE
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0151
Mailing Address - Country:US
Mailing Address - Phone:405-573-3945
Mailing Address - Fax:405-573-3960
Practice Address - Street 1:320 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5238
Practice Address - Country:US
Practice Address - Phone:405-573-3811
Practice Address - Fax:405-573-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEXEMPT BY STATUTE261QM2500X, 283Q00000X
OK323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100726320AMedicaid
OK100698370AMedicaid