Healthcare Provider Details

I. General information

NPI: 1770674756
Provider Name (Legal Business Name): CHILDRENS' RECOVERY CENTER OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 12TH AVE NE
NORMAN OK
73071-5238
US

IV. Provider business mailing address

PO BOX 151 ATTN: GMH FINANCE
NORMAN OK
73070-0151
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-3811
  • Fax: 405-573-3804
Mailing address:
  • Phone: 405-573-3945
  • Fax: 405-573-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberEXEMPT BY STATUTE
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberEXEMPT BY STATUTE
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateOK

VIII. Authorized Official

Name: MRS. TERESA O CAPPS
Title or Position: EXECUTIVE DIRECTOR
Credential: MED LPC CM
Phone: 405-573-3811