Provider Demographics
NPI:1912266644
Name:YWCA
Entity Type:Organization
Organization Name:YWCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICTIM ADVOCATE
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:AMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-234-7581
Mailing Address - Street 1:112 S. HOOVER
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 S QUNICY
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73702
Practice Address - Country:US
Practice Address - Phone:580-747-4878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK302F00000X302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization