Healthcare Provider Details

I. General information

NPI: 1649302373
Provider Name (Legal Business Name): YWCA ENID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S QUINCY ST
ENID OK
73701-5456
US

IV. Provider business mailing address

525 S QUINCY ST
ENID OK
73701-5456
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-7581
  • Fax: 580-234-1284
Mailing address:
  • Phone: 580-234-7581
  • Fax: 580-234-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: KIM BLANKENSHIP
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 580-234-7581