Provider Demographics
NPI:1790990612
Name:NORTHCARE
Entity Type:Organization
Organization Name:NORTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:BA,CM
Authorized Official - Phone:405-272-0660
Mailing Address - Street 1:2429 SW 80TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-4907
Mailing Address - Country:US
Mailing Address - Phone:405-623-1184
Mailing Address - Fax:
Practice Address - Street 1:1140 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3918
Practice Address - Country:US
Practice Address - Phone:405-272-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health