Healthcare Provider Details

I. General information

NPI: 1174898142
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S HUDSON AVE
OKLAHOMA CITY OK
73109-5336
US

IV. Provider business mailing address

PO BOX 30589 12716 NE 36TH STREET
MIDWEST CITY OK
73140-3589
US

V. Phone/Fax

Practice location:
  • Phone: 405-769-3301
  • Fax: 405-769-9685
Mailing address:
  • Phone: 405-769-3301
  • Fax: 405-769-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSALYN JOHNSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA
Phone: 405-769-3301