Provider Demographics
NPI:1841498078
Name:FAMILY SHELTER OF SOUTHERN OKLAHOMA FOR VICTIMS OF DOMESTIC VIOLENCE
Entity type:Organization
Organization Name:FAMILY SHELTER OF SOUTHERN OKLAHOMA FOR VICTIMS OF DOMESTIC VIOLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-226-3750
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402-1408
Mailing Address - Country:US
Mailing Address - Phone:580-226-3750
Mailing Address - Fax:580-226-6470
Practice Address - Street 1:116 C ST SW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6304
Practice Address - Country:US
Practice Address - Phone:580-226-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health