Healthcare Provider Details

I. General information

NPI: 1609193135
Provider Name (Legal Business Name): CEDAR RIDGE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 NE 50TH ST
OKLAHOMA CITY OK
73141-9118
US

IV. Provider business mailing address

6501 NE 50TH ST
OKLAHOMA CITY OK
73141-9118
US

V. Phone/Fax

Practice location:
  • Phone: 405-605-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number322D00000X
License Number StateOK

VIII. Authorized Official

Name: MR. CHANDELL TYRONE BELL
Title or Position: MENTAL HEALTH TECHNICIAN
Credential:
Phone: 405-532-3872