Provider Demographics
NPI:1881716900
Name:CHILDRENS' RECOVERY CENTER OF OKLAHOMA
Entity type:Organization
Organization Name:CHILDRENS' RECOVERY CENTER OF OKLAHOMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR (INTERIM)
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:O
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MED LPC CM
Authorized Official - Phone:405-573-3811
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:ATTN: GMH FINANCE
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0151
Mailing Address - Country:US
Mailing Address - Phone:405-573-3811
Mailing Address - Fax:405-573-3960
Practice Address - Street 1:320 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5238
Practice Address - Country:US
Practice Address - Phone:405-573-3811
Practice Address - Fax:405-573-3960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS' RECOVERY CENTER OF OKLAHOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-06
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100688950BMedicaid