Provider Demographics
NPI:1992017677
Name:GARVIN COUNTY TREATMENT CENTER
Entity Type:Organization
Organization Name:GARVIN COUNTY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:405-207-9050
Mailing Address - Street 1:101 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-5301
Mailing Address - Country:US
Mailing Address - Phone:405-207-9050
Mailing Address - Fax:405-207-9051
Practice Address - Street 1:101 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-5301
Practice Address - Country:US
Practice Address - Phone:405-207-9050
Practice Address - Fax:405-207-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility