Healthcare Provider Details

I. General information

NPI: 1891061636
Provider Name (Legal Business Name): OKLAHOMA CRISIS RECOVERY UNIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

IV. Provider business mailing address

2625 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-9373
  • Fax: 405-579-8741
Mailing address:
  • Phone: 405-948-9373
  • Fax: 405-579-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JO BETH FANCHER
Title or Position: DIVISION DIRECTOR REIMBURSEMENT
Credential:
Phone: 405-573-3949