Healthcare Provider Details

I. General information

NPI: 1376860551
Provider Name (Legal Business Name): SAFY OF OKLAHOMA - LAWTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 NW HOMESTEAD DR SUITE G
LAWTON OK
73505-5243
US

IV. Provider business mailing address

1320 NW HOMESTEAD DR SUITE G
LAWTON OK
73505-5243
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-8883
  • Fax: 580-355-8885
Mailing address:
  • Phone: 580-355-8883
  • Fax: 580-355-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HOLLENKAMP
Title or Position: CPA SENIOR VP OF FINANCE
Credential:
Phone: 419-695-8010