Healthcare Provider Details

I. General information

NPI: 1104915107
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

905 N WILLARD ST
ALTUS OK
73521-3237
US

IV. Provider business mailing address

PO BOX 1088
ALTUS OK
73522-1088
US

V. Phone/Fax

Practice location:
  • Phone: 580-482-1290
  • Fax: 580-482-1293
Mailing address:
  • Phone: 580-482-5040
  • Fax: 580-482-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

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