Healthcare Provider Details

I. General information

NPI: 1225686504
Provider Name (Legal Business Name): THE CHILDREN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 NW 39TH EXPY
BETHANY OK
73008-2513
US

IV. Provider business mailing address

6800 NW 39TH EXPY
BETHANY OK
73008-2513
US

V. Phone/Fax

Practice location:
  • Phone: 405-440-9866
  • Fax: 405-438-3834
Mailing address:
  • Phone: 405-440-9866
  • Fax: 405-438-3834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICO GOMEZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 405-789-6711