Healthcare Provider Details

I. General information

NPI: 1760696355
Provider Name (Legal Business Name): NORTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4436 NW 50TH ST
OKLAHOMA CITY OK
73112-2212
US

IV. Provider business mailing address

1001 NW 21ST ST APT B
OKLAHOMA CITY OK
73106-6210
US

V. Phone/Fax

Practice location:
  • Phone: 405-858-2700
  • Fax: 405-858-2880
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JILL R CLINE
Title or Position: CHILD AND ADOLESCENT THERAPIST
Credential:
Phone: 405-858-2861