Provider Demographics
NPI:1790057057
Name:NARCONON OF OKLAHOMA, INC.
Entity Type:Organization
Organization Name:NARCONON OF OKLAHOMA, INC.
Other - Org Name:ARROWHEAD MEDICAL DETOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-339-5800
Mailing Address - Street 1:69 ARROWHEAD LOOP
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74425-5012
Mailing Address - Country:US
Mailing Address - Phone:918-339-5800
Mailing Address - Fax:
Practice Address - Street 1:1500 S GEORGE NIGH EXPY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7409
Practice Address - Country:US
Practice Address - Phone:918-339-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility