Provider Demographics
NPI:1790089829
Name:SOUTHERN OKLAHOMA TREATMENT SERVICES
Entity Type:Organization
Organization Name:SOUTHERN OKLAHOMA TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580580-745-9610
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:OK
Mailing Address - Zip Code:73449-0048
Mailing Address - Country:US
Mailing Address - Phone:580-745-9610
Mailing Address - Fax:
Practice Address - Street 1:5862 US HWY 70
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:OK
Practice Address - Zip Code:73449
Practice Address - Country:US
Practice Address - Phone:580-745-9610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20938320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness