Provider Demographics
NPI:1891023115
Name:FAMILY SHELTER OF SOUTHERN OKLAHOMA
Entity Type:Organization
Organization Name:FAMILY SHELTER OF SOUTHERN OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHELTER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:580-226-6424
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-1408
Mailing Address - Country:US
Mailing Address - Phone:580-226-6424
Mailing Address - Fax:580-226-6470
Practice Address - Street 1:117 B ST SW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6401
Practice Address - Country:US
Practice Address - Phone:580-226-6424
Practice Address - Fax:580-226-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty