Provider Demographics
NPI:1790908218
Name:SOUTHWEST FOSTER CARE OF OKLAHOMA, INC.
Entity Type:Organization
Organization Name:SOUTHWEST FOSTER CARE OF OKLAHOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-376-4200
Mailing Address - Street 1:10306 N 138TH E AVE
Mailing Address - Street 2:102
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4666
Mailing Address - Country:US
Mailing Address - Phone:918-376-4200
Mailing Address - Fax:918-376-4252
Practice Address - Street 1:10306 N 138TH E AVE
Practice Address - Street 2:102
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4666
Practice Address - Country:US
Practice Address - Phone:918-376-4200
Practice Address - Fax:918-376-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2016-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health