Provider Demographics
NPI:1457550329
Name:KI BOIS COMMUNITY ACTION FOUNDATION, INC.
Entity Type:Organization
Organization Name:KI BOIS COMMUNITY ACTION FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:CCAP
Authorized Official - Phone:918-967-3325
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:200 SE A
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0727
Mailing Address - Country:US
Mailing Address - Phone:918-967-3325
Mailing Address - Fax:918-967-8660
Practice Address - Street 1:200 SE A
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-0727
Practice Address - Country:US
Practice Address - Phone:918-967-3325
Practice Address - Fax:918-967-8660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KI BOIS COMMUNITY ACTION FOUNDATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-12
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171WH0202X, 251G00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities