Healthcare Provider Details

I. General information

NPI: 1215250311
Provider Name (Legal Business Name): MECCA HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 NE 23RD ST
OKLAHOMA CITY OK
73111-3085
US

IV. Provider business mailing address

1322 NE 23RD ST
OKLAHOMA CITY OK
73111-3085
US

V. Phone/Fax

Practice location:
  • Phone: 405-427-8777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LABEEB A. MUWWAKKIL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-427-8777