Provider Demographics
NPI:1477659324
Name:ADULT DAY SERVICES OF SOUTHERN OKLAHOMA, INC.
Entity type:Organization
Organization Name:ADULT DAY SERVICES OF SOUTHERN OKLAHOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KITTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-223-6226
Mailing Address - Street 1:1902 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1217
Mailing Address - Country:US
Mailing Address - Phone:580-223-6226
Mailing Address - Fax:
Practice Address - Street 1:1902 SHENANDOAH DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1217
Practice Address - Country:US
Practice Address - Phone:580-223-6226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKDC1001-1001385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child