Healthcare Provider Details

I. General information

NPI: 1477643104
Provider Name (Legal Business Name): OFFICE OF JUVENILE AFFAIRS, STATE OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 N SANTA FE AVE STE 400
OKLAHOMA CITY OK
73118-8500
US

IV. Provider business mailing address

PO BOX 268812
OKLAHOMA CITY OK
73126-8812
US

V. Phone/Fax

Practice location:
  • Phone: 405-530-2800
  • Fax: 405-530-2911
Mailing address:
  • Phone: 405-530-2800
  • Fax: 405-530-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT EUGENE CHRISTIAN
Title or Position: DIRECTOR
Credential:
Phone: 405-530-2800