Healthcare Provider Details

I. General information

NPI: 1336235910
Provider Name (Legal Business Name): THE CHILDREN'S CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
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: 405-789-6711
  • Fax: 405-789-0690
Mailing address:
  • Phone: 405-789-6711
  • Fax: 405-789-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2340
License Number StateOK

VIII. Authorized Official

Name: MR. NICO GOMEZ
Title or Position: CEO
Credential:
Phone: 405-789-6711