Provider Demographics
NPI:1801317821
Name:SUBSTANCE ABUSE FOUNDATIION FOR EDUCAITON
Entity type:Organization
Organization Name:SUBSTANCE ABUSE FOUNDATIION FOR EDUCAITON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:405-310-0150
Mailing Address - Street 1:2500 MCGEE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-6705
Mailing Address - Country:US
Mailing Address - Phone:405-310-0150
Mailing Address - Fax:405-573-9727
Practice Address - Street 1:1618 SE 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-7314
Practice Address - Country:US
Practice Address - Phone:405-310-0150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9613245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children