Provider Demographics
NPI:1104915107
Name:SOUTHWEST OKLAHOMA COMMUNITY ACTION GROUP, INC.
Entity type:Organization
Organization Name:SOUTHWEST OKLAHOMA COMMUNITY ACTION GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:CCAP
Authorized Official - Phone:580-482-5040
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-1088
Mailing Address - Country:US
Mailing Address - Phone:580-482-5040
Mailing Address - Fax:580-482-5433
Practice Address - Street 1:905 N WILLARD ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3237
Practice Address - Country:US
Practice Address - Phone:580-482-1290
Practice Address - Fax:580-482-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals