Healthcare Provider Details

I. General information

NPI: 1518392356
Provider Name (Legal Business Name): AREA YOUTH SHELTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 09/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W 18TH ST
ADA OK
74820-7423
US

IV. Provider business mailing address

901 W 18TH ST
ADA OK
74820-7423
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-6130
  • Fax:
Mailing address:
  • Phone: 580-436-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JAMES G BEGIN
Title or Position: MANAGER
Credential:
Phone: 580-436-6130