Healthcare Provider Details

I. General information

NPI: 1598854598
Provider Name (Legal Business Name): SOUTHWEST OKLAHOMA COMMUNITY ACTION GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 ENTERPRISE DR
ALTUS OK
73521-5843
US

IV. Provider business mailing address

PO BOX 1088
ALTUS OK
73522-1088
US

V. Phone/Fax

Practice location:
  • Phone: 580-477-0701
  • Fax: 580-477-0702
Mailing address:
  • Phone: 580-482-5040
  • Fax: 580-482-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberDC3301-3301
License Number StateOK

VIII. Authorized Official

Name: MR. NEIL MONTGOMERY
Title or Position: EXECUTIVE DIRECTOR
Credential: C.C.A.P.
Phone: 580-482-5040