Healthcare Provider Details

I. General information

NPI: 1801014550
Provider Name (Legal Business Name): MONARCH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 W BROADWAY ST
MUSKOGEE OK
74401-2761
US

IV. Provider business mailing address

2310 W BROADWAY ST
MUSKOGEE OK
74401-2761
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-7210
  • Fax: 918-682-0801
Mailing address:
  • Phone: 918-682-7210
  • Fax: 918-682-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number651.00
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE L ROGERS
Title or Position: EXECUTIVE ASSISTANT/MANAGER
Credential: BS, CADC/U BHRS
Phone: 918-463-2581