Healthcare Provider Details

I. General information

NPI: 1083089122
Provider Name (Legal Business Name): TRC THE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 NW 25TH ST
OKLAHOMA CITY OK
73106
US

IV. Provider business mailing address

1215 NW 25TH ST
OKLAHOMA CITY OK
73106-5629
US

V. Phone/Fax

Practice location:
  • Phone: 405-525-2525
  • Fax: 405-524-3549
Mailing address:
  • Phone: 405-525-2525
  • Fax: 405-524-3549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARC A NOTO
Title or Position: COO
Credential:
Phone: 405-525-2525