Provider Demographics
NPI:1790887602
Name:OKLAHOMA FAMILIES FIRST INC
Entity Type:Organization
Organization Name:OKLAHOMA FAMILIES FIRST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA/UR DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-360-2133
Mailing Address - Street 1:2600 VAN BUREN ST STE 2634
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-5610
Mailing Address - Country:US
Mailing Address - Phone:405-360-2133
Mailing Address - Fax:405-360-4821
Practice Address - Street 1:2015 W BROADWAY ST STE 51A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2501
Practice Address - Country:US
Practice Address - Phone:580-226-9388
Practice Address - Fax:580-226-9395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKLAHOMA FAMILIES FIRST, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-01
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744520 BMedicaid