Healthcare Provider Details

I. General information

NPI: 1265513501
Provider Name (Legal Business Name): COMANCHE COUNTY NUTRITION PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW SHERIDAN RD
LAWTON OK
73505-1529
US

IV. Provider business mailing address

PO BOX 2231
LAWTON OK
73502-2231
US

V. Phone/Fax

Practice location:
  • Phone: 580-357-7764
  • Fax: 580-357-4774
Mailing address:
  • Phone: 580-357-7764
  • Fax: 580-357-4774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: JULIE JUSTICE
Title or Position: DIRECTOR
Credential:
Phone: 580-357-7764