Healthcare Provider Details

I. General information

NPI: 1922137314
Provider Name (Legal Business Name): CBW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W 4TH ST
KONAWA OK
74849-1612
US

IV. Provider business mailing address

PO BOX 339
KONAWA OK
74849-0339
US

V. Phone/Fax

Practice location:
  • Phone: 580-925-3618
  • Fax:
Mailing address:
  • Phone: 580-925-3618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License NumberRO67-RO67
License Number StateOK

VIII. Authorized Official

Name: MRS. MARY ROSE WEBB
Title or Position: PRESIDENT
Credential:
Phone: 405-527-5473