Provider Demographics
NPI:1295995488
Name:L.C.A.R.C.,INC
Entity type:Organization
Organization Name:L.C.A.R.C.,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-282-8699
Mailing Address - Street 1:PO BOX 1574
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-1574
Mailing Address - Country:US
Mailing Address - Phone:405-282-8699
Mailing Address - Fax:405-282-0988
Practice Address - Street 1:319 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044
Practice Address - Country:US
Practice Address - Phone:405-282-8699
Practice Address - Fax:405-282-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100633430Medicaid