Healthcare Provider Details

I. General information

NPI: 1821393323
Provider Name (Legal Business Name): CARE FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 N KELLEY AVE SUITE 100
OKLAHOMA CITY OK
73111-4520
US

IV. Provider business mailing address

3621 N KELLEY AVE SUITE 100
OKLAHOMA CITY OK
73111-4520
US

V. Phone/Fax

Practice location:
  • Phone: 405-621-5952
  • Fax: 405-621-5952
Mailing address:
  • Phone: 405-621-5952
  • Fax: 405-621-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number101YA0400X
License Number StateOK

VIII. Authorized Official

Name: JOSEPH DISMUKE
Title or Position: MANAGER
Credential:
Phone: 405-524-5525