Healthcare Provider Details

I. General information

NPI: 1215137401
Provider Name (Legal Business Name): CENTER OF FAMILY LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 WEST TEXAS
OKARCHE OK
73762-0245
US

IV. Provider business mailing address

6TH AND TEXAS P.O. BOX 245
OKARCHE OK
73762-0245
US

V. Phone/Fax

Practice location:
  • Phone: 405-263-4658
  • Fax: 405-263-4718
Mailing address:
  • Phone: 405-263-4658
  • Fax: 405-263-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberNH0901-0901
License Number StateOK

VIII. Authorized Official

Name: MR. JIM OBRIEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-263-4658