Provider Demographics
NPI:1295994663
Name:VCPHCS IV, LLC
Entity type:Organization
Organization Name:VCPHCS IV, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:DRAUDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-346-3821
Mailing Address - Street 1:5950 SHERRY LN
Mailing Address - Street 2:SUITE 750
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6533
Mailing Address - Country:US
Mailing Address - Phone:214-346-3821
Mailing Address - Fax:214-346-3808
Practice Address - Street 1:5401 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-7602
Practice Address - Country:US
Practice Address - Phone:405-681-2003
Practice Address - Fax:405-681-2013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VCPHCS, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty