Healthcare Provider Details

I. General information

NPI: 1982213633
Provider Name (Legal Business Name): RED ROCK BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 W 3RD ST
ELK CITY OK
73644-4323
US

IV. Provider business mailing address

1016 W D AVE
ELK CITY OK
73644-3338
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-5136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MELANIE GREENWAY
Title or Position: MEDICATION CLINIC COORDINATOR
Credential:
Phone: 580-799-4672