Healthcare Provider Details

I. General information

NPI: 1447438189
Provider Name (Legal Business Name): WESLEYAN YOUTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N CLASSEN BLVD SUITE 200
OKLAHOMA CITY OK
73118-4834
US

IV. Provider business mailing address

4500 N CLASSEN BLVD SUITE 200
OKLAHOMA CITY OK
73118-4834
US

V. Phone/Fax

Practice location:
  • Phone: 405-524-4457
  • Fax: 405-524-5762
Mailing address:
  • Phone: 405-524-4457
  • Fax: 405-524-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberK86000030
License Number StateOK

VIII. Authorized Official

Name: MS. JAN SILLS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-524-4457