Healthcare Provider Details

I. General information

NPI: 1366758351
Provider Name (Legal Business Name): FAITH CHRISTIAN FELLOWSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21113 COUNTY ST 2520
HYDRO OK
73048
US

IV. Provider business mailing address

PO BOX 545
EAKLY OK
73033-0545
US

V. Phone/Fax

Practice location:
  • Phone: 405-668-2310
  • Fax:
Mailing address:
  • Phone: 405-668-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOK

VIII. Authorized Official

Name: MRS. CHERYL RENEE PARTRIDGE
Title or Position: DIRECTOR
Credential: RN
Phone: 405-668-2310