Healthcare Provider Details

I. General information

NPI: 1407978331
Provider Name (Legal Business Name): REACH OUT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 21
ANADARKO OK
73005-9609
US

IV. Provider business mailing address

PO BOX 38
ANADARKO OK
73005-0038
US

V. Phone/Fax

Practice location:
  • Phone: 405-247-6189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number100649140B
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number100649140E
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number100649140F
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number100649140C
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number100649140A
License Number StateOK

VIII. Authorized Official

Name: MRS. WANDA JEAN FOWLER
Title or Position: CEO
Credential:
Phone: 405-247-6189